Provider Demographics
NPI:1134105679
Name:JANSEN ORTHOPAEDIC CLINIC, LLC
Entity Type:Organization
Organization Name:JANSEN ORTHOPAEDIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-267-2663
Mailing Address - Street 1:2124 N BIOMET DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-7858
Mailing Address - Country:US
Mailing Address - Phone:574-267-2663
Mailing Address - Fax:
Practice Address - Street 1:2124 N BIOMET DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-7858
Practice Address - Country:US
Practice Address - Phone:574-267-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDD7695OtherRR MEDICARE
IN200522700AMedicaid
INDD7695OtherRR MEDICARE