Provider Demographics
NPI:1063145183
Name:MERRILLVILLE ORTHOPEDICS AND SPINE INSTITUTE LLC
Entity type:Organization
Organization Name:MERRILLVILLE ORTHOPEDICS AND SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RERRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-791-0543
Mailing Address - Street 1:255 E 90TH DR STE W1
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8145
Mailing Address - Country:US
Mailing Address - Phone:219-791-0543
Mailing Address - Fax:219-791-0566
Practice Address - Street 1:255 E 90TH DR STE W1
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8145
Practice Address - Country:US
Practice Address - Phone:219-791-0543
Practice Address - Fax:219-791-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty