Healthcare Provider Details

I. General information

NPI: 1871222422
Provider Name (Legal Business Name): INDIANA JOINT REPLACEMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 MAGNAVOX WAY STE B
FORT WAYNE IN
46804-1537
US

IV. Provider business mailing address

3834 S EMERSON AVE STE A
INDIANAPOLIS IN
46203-5902
US

V. Phone/Fax

Practice location:
  • Phone: 317-620-0232
  • Fax: 260-208-9561
Mailing address:
  • Phone: 317-620-0232
  • Fax: 260-208-9561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MENEGHINI
Title or Position: OWNER
Credential:
Phone: 317-620-0232