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NPI Code Detail

MEDICARE: ASCENDANT ORTHOPEDIC ALLIANCE, LLC

MEDICARE: ASCENDANT ORTHOPEDIC ALLIANCE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1164934295
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASCENDANT ORTHOPEDIC ALLIANCE, LLC
Provider Business Mailing Address
First Line : 2310 CALIFORNIA RD STE A
Second Line :
City : ELKHART
State : IN
Zip : 46514-1228
Country : US
Telephone Number : 574-264-0791
Fax Number : 574-262-9650
Provider Business Practice Location Address
First Line : 60160 BODNAR BLVD
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-9338
Country : US
Telephone Number : 574-247-9441
Fax Number : 574-247-9442
Authorized Official
Title or Position : CFO
Name : JACQUELINE A KERWIN
Credential :
Telephone Number : 574-206-8069
Provider Enumeration Date : 10/30/2017
Last Update Date : 10/30/2017

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Directions to “ASCENDANT ORTHOPEDIC ALLIANCE, LLC ” Practice Location

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