Directclinic Sbc, LLC
Clinic/Center, Primary Care in Fort Wayne, IN. Organization (NPI-2).
NPI number1336733229
StatusActive
Last updated in NPPESNov 30, 2021
Details
- NPI
- 1336733229
- Entity type
- Organization (NPI-2)
- Legal business name
- Directclinic Sbc, LLC
- Organization subpart
- No
- Enumeration date
- Feb 22, 2021
- Certification date
- Nov 30, 2021
- Last updated
- Nov 30, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Other names
- Directclinic (Doing Business As)
Practice location
1355 Getz Rd Ste CFort Wayne, IN 46804-1609
Phone 260-212-1900
Mailing address
1355 Getz Rd Ste CFort Wayne, IN 46804-1609
Phone 260-212-1900
Authorized official
Sudhakar Santhana Krishnan
Ceo
2607500418
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