| Su Salud Clinic PSC | |
|
4101 Diplomat Plaza Ctr Fort Wayne IN 46806-4531 | |
| (260) 444-5695 | |
| (260) 444-5665 |
| Full Name | Su Salud Clinic PSC |
|---|---|
| Speciality | Family Medicine |
| Location | 4101 Diplomat Plaza Ctr, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mario Augusto Gomez (FAMILY PRACTICE/OWNER) |
| Authorized Official Contact | 2604445695 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Su Salud Clinic PSC 4101 Diplomat Plaza Ctr Fort Wayne IN 46806-4531 Ph: (260) 444-5695 | Su Salud Clinic PSC 4101 Diplomat Plaza Ctr Fort Wayne IN 46806-4531 Ph: (260) 444-5695 |
| NPI Number | 1689941932 |
|---|---|
| Provider Enumeration Date | 11/30/2011 |
| Last Update Date | 07/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689941932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01056928A (Indiana) | Primary |
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