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ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA INC NPI 1295397735


NPI Information

NPI: 1295397735
Provider Name: ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC
Classification: Prosthetic/Orthotic Supplier - 335E00000X
Entity Type: Organization

CLIA Number: 15D1078025

Address:
200 E JACKSON BLVD STE 130
ELKHART, IN
ZIP 46516
Phone: (574) 264-0791
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ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC is a prosthetic orthotic supplier in Elkhart, IN. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC NPI is 1295397735. The provider is registered as an organization entity type.

The provider's business location address is:

200 E JACKSON BLVD STE 130
ELKHART, IN
ZIP 46516-513
Phone: (574) 264-0791
Fax: (574) 264-5183

The provider's authorized official is Robin S. Mclaughlin .
The authorized official title is Cao and has the following contact phone number (574) 970-4455.

The CLIA number assigned to this NPI record is 15D1078025 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/5/2019 and was last updated on 7/5/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1300026304MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.