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General NPI Number Information
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NPI Number | 1013742477
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Entity Type | Organization
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Legal Business Name | CENTRAL INDIANA ORTHOPEDICS LLC
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 541 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3239
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Country | US
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Telephone | 317-455-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 W BETHEL AVE
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City | MUNCIE
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State | IN
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Zip | 47304-5407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTOR MORAN
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Credential |
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Telephone | 800-622-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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