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SU SALUD CLINIC PSC NPI 1689941932


NPI Information

NPI: 1689941932
Provider Name: SU SALUD CLINIC PSC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
4101 DIPLOMAT PLAZA CTR
FORT WAYNE, IN
ZIP 46806
Phone: (260) 444-5695
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SU SALUD CLINIC PSC is a family medicine in Fort Wayne, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SU SALUD CLINIC PSC NPI is 1689941932. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4101 DIPLOMAT PLAZA CTR
FORT WAYNE, IN
ZIP 46806-531
Phone: (260) 444-5695
Fax: (260) 444-5665

The provider's authorized official is Mario Augusto Gomez .
The authorized official title is Family Practice/owner and has the following contact phone number (260) 444-5695.

The enumeration date for this NPI number is 11/30/2011 and was last updated on 7/16/2012.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine01056928AINDIANAYes

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

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