1447421086 NPI number — KEYSTONE ORTHOPEDICS S.C.

Table of content: (NPI 1447421086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447421086 NPI number — KEYSTONE ORTHOPEDICS S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE ORTHOPEDICS S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447421086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 W 177TH ST
Provider Second Line Business Mailing Address:
SUITE 2C
Provider Business Mailing Address City Name:
HAZEL CREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60429-2184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-799-1144
Provider Business Mailing Address Fax Number:
708-799-4899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-4123
Provider Business Practice Location Address Fax Number:
219-836-0276
Provider Enumeration Date:
03/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERTEL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
708-799-1144

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  01036580A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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