Provider Demographics
NPI:1285817700
Name:BONE & JOINT INSTITUTE P C
Entity Type:Organization
Organization Name:BONE & JOINT INSTITUTE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-987-9871
Mailing Address - Street 1:600 FORT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3941
Mailing Address - Country:US
Mailing Address - Phone:810-987-9871
Mailing Address - Fax:810-987-6070
Practice Address - Street 1:600 FORT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3941
Practice Address - Country:US
Practice Address - Phone:810-987-9871
Practice Address - Fax:810-987-6070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BONE & JOINT INSTITUTE P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540G411560OtherBCBS OF MI SUPPLIER PIN
MI0606880001Medicare NSC