MEDICARE: ORTHOMIDWEST, PLLC

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	060010825	IL

General Provider Information

NPI Number	:	1538512462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOMIDWEST, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 735263
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5263
Country	:	US
Telephone Number	:	815-381-7431
Fax Number	:	815-381-7333

Provider Business Practice Location Address
First Line	:	770 BELOIT RD
Second Line	:
City	:	BELVIDERE
State	:	IL
Zip	:	61008-1745
Country	:	US
Telephone Number	:	815-381-7431
Fax Number	:	815-381-7333

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	LESLIE ELMER
Credential	:	CPCS
Telephone Number	:	815-381-7431

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	04/19/2024

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