| Nicholas L. Rico, M.d., P.c. | |
|
3303 Trier Rd Ste 1 Fort Wayne IN 46815-4768 | |
| (260) 483-4260 | |
| (260) 483-6066 |
| Full Name | Nicholas L. Rico, M.d., P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 3303 Trier Rd Ste 1, Fort Wayne, Indiana |
| Authorized Official Name and Position | Nicholas L. Rico (PRESIDENT AND CEO) |
| Authorized Official Contact | 2604834260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas L. Rico, M.d., P.c. 3303 Trier Rd Ste 1 Fort Wayne IN 46815-4768 Ph: (260) 483-4260 | Nicholas L. Rico, M.d., P.c. 3303 Trier Rd Ste 1 Fort Wayne IN 46815-4768 Ph: (260) 483-4260 |
| NPI Number | 1710062690 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 12/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710062690 | NPI | - | NPPES |
| 100079790A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01031164A (Indiana) | Primary |
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