SUPER SHOT NPI 1427373372

NPI Information

SUPER SHOT is a public health or welfare in Fort Wayne, IN. SUPER SHOT NPI is 1427373372. The provider is registered as an organization entity type.

The provider's business location address is:

709 CLAY ST
SUITE 300
FORT WAYNE, IN
ZIP 46802-019
Phone: (260) 424-7468

The provider's authorized official is Kelly Zachrich .
The authorized official title is Executive Director and has the following contact phone number (260) 424-7468.

The enumeration date for this NPI number is 4/5/2010 and was last updated on 6/24/2010.

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:

Other Identifiers

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

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