institution
Super Shot
Public Health or Welfare Agency in Fort Wayne, Indiana
NPI 1427373372

Super Shot is a Public Health or Welfare Agency based in Fort Wayne, IN. Super Shot practices in Fort Wayne, IN. The NPI Number for Super Shot is 1427373372 and holds a License No. N/A (Indiana).

The current practice location address for Super Shot is 709 Clay St, Fort Wayne, IN and can be reached out via phone at 260-424-7468. You can also correspond with Super Shot through the mailing address at 709 CLAY ST, FORT WAYNE, IN - 46802-2019 (mailing address contact number: 260-424-7468).

Location: 709 Clay St, Fort Wayne, IN, 46802-2019
institution
Provider Profile Details
NPI Number
1427373372
Provider Name
Super Shot
Credential
Provider Entity Type
Organization
Address
709 Clay St, Fort Wayne, IN, 46802-2019
Phone Number
260-424-7468
Fax Number
Provider Enumeration Date
04/05/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200977620A 05 IN
institution
Provider Business Practice Location Address Details
Address
709 Clay St
City
State
Zip
46802-2019
Phone Number
260-424-7468
Fax Number
person
Provider Business Mailing Address Details
Address
709 Clay St
City
State
Zip
46802-2019
Phone Number
260-424-7468
Fax Number
person
Provider's Taxonomy Details 1
Type
Agencies
Classification
Public Health or Welfare
Speciality
-
Taxonomy
License No.
N/A (Indiana)
Definition
Definition to come...
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