| Organization Name: | QHG OF FORT WAYNE COMPANY LLC |
| NPI Number: | 1083656573 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
| Mailing Address: | 3717 Maplecrest Rd Fort Wayne |
| State: | IN US |
| Postal Code: | 468158424 |
| Phone Number: | 2604867334 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2006 |
| NPI Last Update Date: | 02/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |