Provider Demographics
NPI:1033155387
Name:ORTHOPAEDIC SURGICAL CARE INSTITUTE
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGICAL CARE INSTITUTE
Other - Org Name:OSCI LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-827-6724
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:1941 VIRGINIA AVE
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331
Mailing Address - Country:US
Mailing Address - Phone:765-827-6724
Mailing Address - Fax:765-827-7972
Practice Address - Street 1:1941 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331
Practice Address - Country:US
Practice Address - Phone:765-827-6724
Practice Address - Fax:765-827-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055711A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200372480Medicaid
H59094Medicare UPIN
IN211280AMedicare ID - Type Unspecified
IN6340510001Medicare NSC