Provider Demographics
NPI:1255352514
Name:MMS FT. WAYNE, INC
Entity type:Organization
Organization Name:MMS FT. WAYNE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:BOBAY
Authorized Official - Suffix:
Authorized Official - Credentials:RFM
Authorized Official - Phone:260-637-8586
Mailing Address - Street 1:14601 LIMA RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9585
Mailing Address - Country:US
Mailing Address - Phone:260-637-8585
Mailing Address - Fax:260-637-1927
Practice Address - Street 1:14601 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9585
Practice Address - Country:US
Practice Address - Phone:260-637-8585
Practice Address - Fax:260-637-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000007A332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN69000007AOtherSTATE LICENSE
IN1084780001Medicare ID - Type Unspecified