Provider Demographics
NPI:1275570012
Name:GOSHEN ORTHOPEDIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GOSHEN ORTHOPEDIC ASSOCIATES, LLC
Other - Org Name:NORTH CENTRAL ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-534-2548
Mailing Address - Street 1:1824 DORCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6476
Mailing Address - Country:US
Mailing Address - Phone:574-534-2548
Mailing Address - Fax:574-534-3622
Practice Address - Street 1:1824 DORCHESTER CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6476
Practice Address - Country:US
Practice Address - Phone:574-534-2548
Practice Address - Fax:574-534-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN170200Medicare ID - Type Unspecified