Provider Demographics
NPI:1437202215
Name:ORTHOPEDIC SURGEONS OF KOKOMO, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGEONS OF KOKOMO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-868-0313
Mailing Address - Street 1:2226 W ALTO RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4840
Mailing Address - Country:US
Mailing Address - Phone:765-868-0313
Mailing Address - Fax:765-454-0554
Practice Address - Street 1:2226 W ALTO RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-4840
Practice Address - Country:US
Practice Address - Phone:765-868-0313
Practice Address - Fax:765-454-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300049637Medicaid
201820Medicare ID - Type Unspecified