INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER INC. NPI 1134395510

NPI Information

NPI: 1134395510
Provider Name: INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC.
Classification: Psychologist - 103TM1800X
Entity Type: Organization

Specialization: Intellectual and Developmental Disabilities

Address:
3030 LAKE AVE STE 7
FT. WAYNE
FORT WAYNE, IN
ZIP 46805
Phone: (260) 422-2838
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INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC. is an intellectual and developmental disabilities in Fort Wayne, IN. INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC. NPI is 1134395510. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3030 LAKE AVE STE 7
FT. WAYNE
FORT WAYNE, IN
ZIP 46805-428
Phone: (260) 422-2838

The provider's authorized official is Patsy A. Donn .
The authorized official title is President And Cfo and has the following contact phone number (260) 422-2838.

The enumeration date for this NPI number is 5/5/2008 and was last updated on 5/5/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TM1800X	Psychologist	Intellectual and Developmental Disabilities	20090014A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100080770 A	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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