Provider Demographics
NPI:1427374875
Name:ORTHOPAEDIC SPECIALISTS PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-344-9292
Mailing Address - Street 1:600 VALLEY VIEW DR
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6118
Mailing Address - Country:US
Mailing Address - Phone:309-277-0117
Mailing Address - Fax:309-277-1001
Practice Address - Street 1:600 VALLEY VIEW DR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6118
Practice Address - Country:US
Practice Address - Phone:309-277-0117
Practice Address - Fax:309-277-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0368560006Medicare NSC