Healthcare Provider Details

I. General information

NPI: 1417936477
Provider Name (Legal Business Name): ORTHOPAEDICS NORTHEAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 PARKVIEW CIRCLE DR
FORT WAYNE IN
46845-1729
US

IV. Provider business mailing address

5050 N CLINTON ST
FORT WAYNE IN
46825-5822
US

V. Phone/Fax

Practice location:
  • Phone: 260-484-8551
  • Fax: 260-490-6996
Mailing address:
  • Phone: 260-484-8551
  • Fax: 260-490-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN C PRITCHARD
Title or Position: PRESIDENT
Credential: MD
Phone: 260-484-8551