Provider Demographics
NPI:1578628640
Name:ORTHOPEDIC & SPINE SURGERY ASSOC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE SURGERY ASSOC
Other - Org Name:MIDWEST BONE & JOINT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-5300
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-5321
Practice Address - Street 1:420 W NORTHWEST HWY
Practice Address - Street 2:SUITE M
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6837
Practice Address - Country:US
Practice Address - Phone:847-382-6766
Practice Address - Fax:847-382-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208821OtherMEDICARE
IL0354460004Medicare NSC