1174534887 NPI number — ORTHOPAEDIC SURGICAL CARE INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174534887 NPI number — ORTHOPAEDIC SURGICAL CARE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC SURGICAL CARE INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174534887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONNERSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-827-6724
Provider Business Mailing Address Fax Number:
765-827-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSHVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-932-5788
Provider Business Practice Location Address Fax Number:
765-827-7972
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ORTHOPAEDIC SURGEON
Authorized Official Telephone Number:
765-827-6724

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  01055711A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000322039 . This is a "BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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