Healthcare Provider Details

I. General information

NPI: 1134203490
Provider Name (Legal Business Name): PUTNAM SURGICAL SPECIALTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST SUITE 1100
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

1542 S BLOOMINGTON ST SUITE 1100
GREENCASTLE IN
46135-2212
US

V. Phone/Fax

Practice location:
  • Phone: 765-658-2710
  • Fax: 765-653-8686
Mailing address:
  • Phone: 765-658-2710
  • Fax: 765-653-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRUDY GOODPASTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 765-655-2671