Provider Demographics
NPI:1174686133
Name:COMPLETE ORTHOPAEDIC CARE, LLC.
Entity Type:Organization
Organization Name:COMPLETE ORTHOPAEDIC CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSSAULT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-634-2266
Mailing Address - Street 1:100 VILLAGE GRN
Mailing Address - Street 2:STE 120
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3094
Mailing Address - Country:US
Mailing Address - Phone:847-634-2266
Mailing Address - Fax:847-634-2894
Practice Address - Street 1:100 VILLAGE GRN
Practice Address - Street 2:STE 120
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3094
Practice Address - Country:US
Practice Address - Phone:847-634-2266
Practice Address - Fax:847-634-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48767Medicare UPIN
ILC39582Medicare UPIN
ILH61699Medicare UPIN
ILD15499Medicare UPIN