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General NPI Number Information
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NPI Number | 1417936477
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDICS NORTHEAST PC
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 11420 PARKVIEW CIRCLE DR
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City | FORT WAYNE
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State | IN
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Zip | 46845-1729
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Country | US
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Telephone | 260-484-8551
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Fax | 260-490-6996
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Provider Business Mailing Address
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Address Line | 5050 N CLINTON ST
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City | FORT WAYNE
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State | IN
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Zip | 46825-5822
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Country | US
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Telephone | 260-484-8551
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Fax | 260-490-6996
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN C PRITCHARD
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Credential | MD
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Telephone | 260-484-8551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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