Provider Demographics
NPI:1497865794
Name:ORTHOPAEDIC SPECIALISTS OF NORTHWEST INDIANA PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF NORTHWEST INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-2652
Mailing Address - Street 1:PO BOX 3329
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0329
Mailing Address - Country:US
Mailing Address - Phone:219-924-3300
Mailing Address - Fax:219-934-2658
Practice Address - Street 1:730 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-924-3300
Practice Address - Fax:219-934-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
129555400OtherUS DEPT LABOR
90000692OtherBCIL
IN200135850AMedicaid
IN000000104771OtherANTHEM GROUP
90000692OtherBCIL
IN200135850AMedicaid
1170000002Medicare NSC