| Pancner Psychiatric Associates, Pc | |
|
2805 Fairfield Ave Fort Wayne IN 46807-1218 | |
| (260) 456-4880 | |
| (260) 456-3559 |
| Full Name | Pancner Psychiatric Associates, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 2805 Fairfield Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | Ronald J Pancner (OWNER) |
| Authorized Official Contact | 2604564880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pancner Psychiatric Associates, Pc 2805 Fairfield Ave Fort Wayne IN 46807-1218 Ph: (260) 456-4880 | Pancner Psychiatric Associates, Pc 2805 Fairfield Ave Fort Wayne IN 46807-1218 Ph: (260) 456-4880 |
| NPI Number | 1801019096 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 04/29/2008 |
| Medicare PECOS PAC ID | 4789615253 |
|---|---|
| Medicare Enrollment ID | O20080208000000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801019096 | NPI | - | NPPES |
| 100049440 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (Indiana) | Primary |
| Provider Name | Edith L Kenna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154358406 PECOS PAC ID: 0446212625 Enrollment ID: I20041029000919 |
| Provider Name | Ronald J Pancner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316980576 PECOS PAC ID: 0547291031 Enrollment ID: I20110520000119 |
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