Provider Demographics
NPI:1376507798
Name:NORRIS & LOVE ORTHOPAEDIC & SPORTS PC
Entity Type:Organization
Organization Name:NORRIS & LOVE ORTHOPAEDIC & SPORTS PC
Other - Org Name:RANDALL G NORRIS MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-634-1211
Mailing Address - Street 1:1900 SAINT CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9145
Mailing Address - Country:US
Mailing Address - Phone:812-634-1211
Mailing Address - Fax:812-634-9762
Practice Address - Street 1:1900 SAINT CHARLES STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9145
Practice Address - Country:US
Practice Address - Phone:812-634-1211
Practice Address - Fax:812-634-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200318380Medicaid
INCH1472Medicare PIN
IN215020Medicare ID - Type Unspecified
IN200318380Medicaid