1801929724 NPI number — SPECIALTY ORTHOPEDICS INC

Table of content: (NPI 1801929724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801929724 NPI number — SPECIALTY ORTHOPEDICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY ORTHOPEDICS INC
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:
1801929724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46563-5507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-935-9395
Provider Business Mailing Address Fax Number:
574-935-0080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 MILLER DR
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46563-8091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-935-9395
Provider Business Practice Location Address Fax Number:
574-935-0080
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHERRON
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
574-935-9395

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2002777260 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com