| Act 3 Care Llc | |
|
7309 Trier Rd Fort Wayne IN 46815-5566 | |
| (260) 515-3275 | |
| Not Available |
| Full Name | Act 3 Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7309 Trier Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Shannon Pace (OFFICE MANAGER) |
| Authorized Official Contact | 3342918360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Act 3 Care Llc 7309 Trier Rd Fort Wayne IN 46815-5566 Ph: () - | Act 3 Care Llc 7309 Trier Rd Fort Wayne IN 46815-5566 Ph: (260) 515-3275 |
| NPI Number | 1023432192 |
|---|---|
| Provider Enumeration Date | 02/10/2014 |
| Last Update Date | 07/18/2023 |
| Medicare PECOS PAC ID | 8123250420 |
|---|---|
| Medicare Enrollment ID | O20140421002052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023432192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| Provider Name | Shelene Ruggio |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1619087707 PECOS PAC ID: 2062306681 Enrollment ID: I20061228000326 |
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