Provider Demographics
NPI:1699729111
Name:SURGICAL SERVICES OF NORTHERN INDIANA, LLC
Entity type:Organization
Organization Name:SURGICAL SERVICES OF NORTHERN INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:574-261-9444
Mailing Address - Street 1:50744 PHEASANT COVE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8835
Mailing Address - Country:US
Mailing Address - Phone:574-273-1232
Mailing Address - Fax:574-272-2220
Practice Address - Street 1:50744 PHEASANT COVE DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8835
Practice Address - Country:US
Practice Address - Phone:574-261-9444
Practice Address - Fax:574-272-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1000226A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR33359Medicare UPIN