MEDICARE: ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285942599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC.

Provider Business Mailing Address
First Line	:	2310 CALIFORNIA RD
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46514-1228
Country	:	US
Telephone Number	:	574-264-0179
Fax Number	:	574-262-9650

Provider Business Practice Location Address
First Line	:	600 NORTH MAIN STREET
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-8608
Country	:	US
Telephone Number	:	574-825-8685
Fax Number	:	574-825-1256

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ROBIN MCLAUGHLIN
Credential	:
Telephone Number	:	574-264-0179

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	11/01/2021

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