HOLTSCLAW MEDICAL CENTRE, LLC (NPI# 1235146812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235146812 |
| Entity Type | Organization |
| Organization Name | HOLTSCLAW MEDICAL CENTRE, LLC |
| Practice Address |
4666 W Jefferson Blvd Suite 140 Fort Wayne IN 46804-6892 |
| Practice Telephone | 2604320100 |
| Mailing Telephone | 2604320100 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LISA MICHELLE HOLTSCLAW (MEMBER) |
| Authorized Official Telephone | 2604320100 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 02001568A | IN | Allopathic & Osteopathic Physicians |
| Street Address |
4666 W JEFFERSON BLVD SUITE 140 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-6892 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235565953 | Cathy Lou Hakes | Nurse Practitioner | 4666 W Jefferson Blvd, Suite 140, Fort Wayne, IN 46804-6892 | 2013-09-26 |
| 1689019861 | Chatter Bug Speech &language Therapy LLC | Speech-Language Pathologist | 4666 W Jefferson Blvd, Ste 144, Fort Wayne, IN 46804-6892 | 2013-05-01 |
| 1649461005 | Sarah D Heck | Nurse Practitioner | 4666 W Jefferson Blvd, Suite 140, Fort Wayne, IN 46804-6892 | 2007-08-09 |
| 1508914623 | Dolorita Rose Sweeney | Psychiatry & Neurology | 4666 W Jefferson Blvd, Suite 144, Fort Wayne, IN 46804-6892 | 2007-01-08 |
| 1366515603 | Hanger Prosthetics & Orthotics Inc | Durable Medical Equipment & Medical Supplies | 4666 W Jefferson Blvd, Ste 140, Fort Wayne, IN 46804-6891 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760912026 | Christina A Tatara | Family Medicine | 6511 E State Blvd, Fort Wayne, IN 46815-7026 | 2017-06-19 |
| 1700317633 | Robert Campbell | Family Medicine | 7411 Hope Dr, Fort Wayne, IN 46815-5687 | 2017-03-22 |
| 1487196424 | American Vein Institute LLC | Family Medicine | 10020 Dupont Circle Ct Ste 140, Fort Wayne, IN 46825-1621 | 2016-11-08 |
| 1831547124 | Anna Menze | Family Medicine | 10307 Dupont Circle Dr W Ste A, Fort Wayne, IN 46825-1633 | 2016-05-27 |
| 1407203672 | Credo Health Group, LLC | Family Medicine | 10228 Dupont Circle Dr E # 100b, Fort Wayne, IN 46825-1611 | 2016-05-18 |
| 1649625104 | Gabrielle Paloma Acquaro | Family Medicine | 7806 W Jefferson Blvd Ste E, Fort Wayne, IN 46804-4180 | 2016-05-03 |
| 1720491731 | John E Marx | Family Medicine | 1007 W Rudisill Blvd, Fort Wayne, IN 46807-2170 | 2014-06-06 |
| 1457763252 | Amy Simpson | Family Medicine | 1818 Carew St Ste 120, Fort Wayne, IN 46805-4764 | 2014-05-28 |
| 1932536083 | Clifford James Shultz | Family Medicine | 2616 Covington Pointe Trl, Fort Wayne, IN 46804-2773 | 2013-10-03 |
| 1164860086 | Andrew J Mullally | Family Medicine | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 | 2013-06-13 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.