Provider Demographics
NPI:1164917050
Name:CENTRAL INDIANA ORTHOPEDIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL INDIANA ORTHOPEDIC SURGERY CENTER, LLC
Other - Org Name:ORTHOALLIANCE OF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-213-3864
Mailing Address - Street 1:3600 W BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5407
Mailing Address - Country:US
Mailing Address - Phone:765-213-3864
Mailing Address - Fax:
Practice Address - Street 1:3600 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5407
Practice Address - Country:US
Practice Address - Phone:765-213-3864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL INDIANA ORTHOPEDIC SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical