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General NPI Number Information
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NPI Number | 1699729111
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Entity Type | Organization
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Legal Business Name | SURGICAL SERVICES OF NORTHERN INDIANA, LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50744 PHEASANT COVE DR
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City | GRANGER
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State | IN
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Zip | 46530-8835
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Country | US
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Telephone | 574-261-9444
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Fax | 574-272-2220
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Provider Business Mailing Address
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Address Line | 50744 PHEASANT COVE DR
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City | GRANGER
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State | IN
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Zip | 46530-8835
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Country | US
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Telephone | 574-273-1232
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Fax | 574-272-2220
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY BARNARD
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Credential | PA-C
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Telephone | 574-261-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1000226A
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License Number State | IN
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