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General NPI Number Information
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NPI Number | 1740268796
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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 | 01/09/2006
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Last Update Date | 05/12/2017
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Provider Practice Location 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 | 260-482-5060
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Provider Business Mailing Address
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Address Line | 5052 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 | CREDENTIALING OFFICER
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Name | BARBARA J HATHAWAY
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Credential |
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Telephone | 260-408-2203
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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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