Fort Wayne Primary Care Llc | |
7802 W Jefferson Blvd Ste A Fort Wayne IN 46804-4138 | |
(260) 999-6924 | |
(260) 222-2844 |
Full Name | Fort Wayne Primary Care Llc |
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Speciality | Internal Medicine |
Location | 7802 W Jefferson Blvd Ste A, Fort Wayne, Indiana |
Authorized Official Name and Position | Vishaal Veerula (OWNER) |
Authorized Official Contact | 2609996924 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Fort Wayne Primary Care Llc 7802 W Jefferson Blvd Ste A Fort Wayne IN 46804-4138 Ph: (260) 999-6924 | Fort Wayne Primary Care Llc 7802 W Jefferson Blvd Ste A Fort Wayne IN 46804-4138 Ph: (260) 999-6924 |
NPI Number | 1528707619 |
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Provider Enumeration Date | 05/27/2022 |
Last Update Date | 05/27/2022 |
Medicare PECOS PAC ID | 6608258116 |
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Medicare Enrollment ID | O20220801000488 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528707619 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Vishaal Veerula |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1336441948 PECOS PAC ID: 5496983033 Enrollment ID: I20140106000852 |
Provider Name | Estelle M Daniel |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861903114 PECOS PAC ID: 7416214317 Enrollment ID: I20171201000504 |
Provider Name | Denise Irene Houck |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528338423 PECOS PAC ID: 8123285533 Enrollment ID: I20230117001796 |
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