Provider Demographics
NPI:1417240284
Name:ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC.
Other - Org Name:OSMC GOSHEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-264-4163
Mailing Address - Street 1:2310 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1228
Mailing Address - Country:US
Mailing Address - Phone:574-264-0791
Mailing Address - Fax:574-262-9650
Practice Address - Street 1:1775 E KERCHER RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6308
Practice Address - Country:US
Practice Address - Phone:574-533-0300
Practice Address - Fax:574-971-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100111780DMedicaid
IN0235070004Medicare NSC
IN223420Medicare PIN