| Southeast Clinic | |
|
3350 E Paulding Rd Fort Wayne IN 46816-4513 | |
| (260) 423-2585 | |
| (260) 422-9261 |
| Full Name | Southeast Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3350 E Paulding Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Angela M Zaegel (PRESIDENT/CEO) |
| Authorized Official Contact | 2604582646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Clinic 1717 S Calhoun St Fort Wayne IN 46802-5257 Ph: (260) 458-2641 | Southeast Clinic 3350 E Paulding Rd Fort Wayne IN 46816-4513 Ph: (260) 423-2585 |
| NPI Number | 1508262916 |
|---|---|
| Provider Enumeration Date | 11/12/2014 |
| Last Update Date | 09/21/2016 |
| Medicare PECOS PAC ID | 8022926294 |
|---|---|
| Medicare Enrollment ID | O20141030000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508262916 | NPI | - | NPPES |
| 100050750B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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