Provider Demographics
NPI:1285942599
Name:ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC.
Entity type:Organization
Organization Name:ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-264-0179
Mailing Address - Street 1:2310 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1228
Mailing Address - Country:US
Mailing Address - Phone:574-264-0179
Mailing Address - Fax:574-262-9650
Practice Address - Street 1:600 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-8608
Practice Address - Country:US
Practice Address - Phone:574-825-8685
Practice Address - Fax:574-825-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100111780BMedicaid
IN0235070003Medicare NSC
IN100111780BMedicaid