Provider Demographics
NPI:1972695237
Name:ORTHOPAEDIC INDIANAPOLIS PC
Entity type:Organization
Organization Name:ORTHOPAEDIC INDIANAPOLIS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-802-2000
Mailing Address - Street 1:252 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1416
Mailing Address - Country:US
Mailing Address - Phone:317-745-6443
Mailing Address - Fax:317-745-6451
Practice Address - Street 1:252 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1416
Practice Address - Country:US
Practice Address - Phone:317-745-6443
Practice Address - Fax:317-745-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN037170Medicare PIN
IN0415760004Medicare NSC