KOSCIUSKO MEDICAL GROUP LLC (NPI# 1932349594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932349594 |
| Entity Type | Organization |
| Organization Name | KOSCIUSKO MEDICAL GROUP LLC |
| Practice Address |
2235 Dubois Dr Warsaw IN 46580-3212 |
| Mailing Address |
6920 Pointe Inverness Way Suite 200 Fort Wayne IN 46804-7934 |
| Practice Telephone | 5742678189 |
| Mailing Telephone | 2604793513 |
| Mailing Fax Number | 2604793520 |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | MICHAEL A SWAW (DIRECTOR) |
| Authorized Official Telephone | 2604793513 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | Other Service Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2501 E Center St, 3rd Floor, Warsaw, IN 465803819 | 5743727617 | 5743727649 |
| Street Address |
2235 DUBOIS DR |
| City | WARSAW |
| State | IN |
| Zip Code | 46580-3212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912998907 | Allied Physicians Inc., D/b/a Indiana Ohio Heart | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2005-10-31 |
| 1013469659 | Sara M. Crooks | Nurse Practitioner | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2016-10-31 |
| 1295109106 | Megan Fisher | Nurse Practitioner | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2015-11-17 |
| 1326434341 | Terrence Mcgrath | Family Medicine | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2015-04-07 |
| 1326271677 | Marcus William Scott | Physician Assistant | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2009-09-02 |
| 1821128265 | Kosciusko Family Healthcare, P.C. | Family Medicine | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2007-03-06 |
| 1952313215 | Nicholas L Finley | Emergency Medicine | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2006-08-13 |
| 1255396529 | Brian David Reichenbach | Family Medicine | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2006-04-19 |
| 1336116201 | Sung Jae Park | Family Medicine | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2006-03-01 |
| 1871569715 | Norman George Macdonald | Family Medicine | 2235 Dubois Dr, Warsaw, IN 46580-3212 | 2006-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346803772 | Amber Rae Parker | Physical Therapy Assistant | 2695 Shelden St., Warsaw, IN 46580 | 2019-04-22 |
| 1194255794 | Tyler Scott Kronk | Counselor | 105 Enterprise Drive, Warsaw, IN 46580 | 2017-06-15 |
| 1306244231 | Indiana Physical Therapy, Inc. | Clinic/Center | 3300 Lake City Hwy., Warsaw, IN 46580 | 2014-12-09 |
| 1922434687 | Yen Thi Vu | Pharmacist | 2400 East Center St, Warsaw, IN 46580 | 2013-09-25 |
| 1982956934 | Marsha Lynn Dreyer | Occupational Therapy Assistant | 300 E. Prairie Street, Warsaw, IN 46580 | 2012-10-15 |
| 1215286109 | Planned Parenthood of Indiana Warsaw | Clinic/Center | 630 S. Buffalo St., Suite 1, Warsaw, IN 46580 | 2012-09-06 |
| 1952636243 | Magdi Gabriel | Orthopaedic Surgery | 2087 Phaesant Ridge Drive, Warsaw, IN 46580 | 2009-10-05 |
| 1316132996 | Assisted Living Concepts Inc | Assisted Living Facility | 425 Chinworth Court, Warsaw, IN 46580 | 2007-09-07 |
| 1598986101 | Ericka Ester Haynes | Occupational Therapist | 900 Provident Drive, Warsaw, IN 46580 | 2007-05-01 |
| 1881819555 | Hartwiger Enterprises, Inc. | Home Health | 3510 Commerce Dr., Warsaw, IN 46580 | 2007-04-16 |
| Find all providers in zip 46580 | ||||
| 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 |
|---|---|---|---|---|
| 1205948486 | Warsaw Health System LLC | Family Medicine | 1210 Provident Dr, Suite B, Warsaw, IN 46580-3266 | 2006-08-31 |
| 1730101759 | Robert Theodore Longshore | Family Medicine | 870 Us Hwy 42 W, Warsaw, KY 41095-9323 | 2006-07-25 |
| 1427083435 | Qutubuddin Karamat Dar | Family Medicine | 31 Duncan St, Suite 1, Warsaw, NY 14569-1017 | 2006-07-11 |
| 1598798407 | Ccmh Corporation | Family Medicine | 202 Franklin Street, Warsaw, KY 41095 | 2006-07-07 |
| 1063448231 | Abayomi S Adediran | Family Medicine | 113 S Pine St, Warsaw, NC 28398-1924 | 2006-06-22 |
| 1972546927 | Erin B Jungbauer | Family Medicine | 1210 Provident Drive, Ste B, Warsaw, IN 46580 | 2006-06-14 |
| 1831151869 | Shawn E Kidder | Family Medicine | 2235 Dubois Drive, Warsaw, IN 46580-3212 | 2006-04-05 |
| 1467428318 | Gary M Pitts | Family Medicine | 2300 Dubois Dr, Warsaw, IN 46580-3213 | 2006-02-28 |
| 1295705622 | Community Health Centers of Southeastern Iowa Inc | Family Medicine | 345 Polk St, Warsaw, IL 62379-1033 | 2006-01-26 |
| 1972591030 | Theodore J Beltz | Family Medicine | 1765 Commercial St, Warsaw, MO 65355-3096 | 2005-10-12 |
| Find all providers in WARSAW | ||||
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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.