RETINA INSTITUTE OF INDIANA SURGERY CENTER, LLC
NPI 1730442559
Clinic/Center - Ambulatory Surgical in Fort Wayne, IN
- Organization
- Clinic/Center
- Ambulatory Surgical
About RETINA INSTITUTE OF INDIANA SURGERY CENTER, LLC
This page provides the complete NPI Profile along with additional information for Retina Institute Of Indiana Surgery Center, Llc, a provider established in Fort Wayne, Indiana operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1730442559 assigned on June 2012. The practitioner's primary taxonomy code is 261QA1903X with license number 13 012741 1 (IN). The provider is registered as an organization and their NPI record was last updated 10 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Gohar Azam Salam Md (Sole Mbr)
- NPI
- 1730442559 Verify this NPI
- Provider Name
- RETINA INSTITUTE OF INDIANA SURGERY CENTER, LLC
- Entity Type
- Organization
- Location Address
- 11192 DIEBOLD RD FORT WAYNE, IN 46845
- Location Phone
- (260) 483-9500
- Location Fax
- (260) 483-9511
- Mailing Address
- 11192 DIEBOLD RD FORT WAYNE, IN 46845
- Mailing Phone
- (260) 483-9500
- Mailing Fax
- (260) 483-9511
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-18-2012
- Last Update Date
- 03-03-2016
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
- License No.
- 13 012741 1
- License State
- IN
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | 01058885A (IN) |
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1730442559, enumerated as an "organization" on June 18, 2012.
The provider is located at 11192 DIEBOLD RD FORT WAYNE, IN 46845 and the phone number is (260) 483-9500.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
