Provider Demographics
NPI:1578788022
Name:NORTHWEST ORTHOPEDIC SURGERY, S.C.
Entity Type:Organization
Organization Name:NORTHWEST ORTHOPEDIC SURGERY, S.C.
Other - Org Name:NORTHWEST REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-870-4200
Mailing Address - Street 1:3030 W SALT CREEK LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5001
Mailing Address - Country:US
Mailing Address - Phone:847-870-4200
Mailing Address - Fax:847-870-0059
Practice Address - Street 1:3030 W SALT CREEK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5001
Practice Address - Country:US
Practice Address - Phone:847-870-4200
Practice Address - Fax:847-870-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42-3132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634499OtherBCBS
IL0496210004Medicare NSC
IL01634499OtherBCBS