Provider Demographics
NPI:1639174873
Name:INDIANA ORTHOPEDICS, INC
Entity Type:Organization
Organization Name:INDIANA ORTHOPEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHOTIST/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:FURTO
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:219-924-2044
Mailing Address - Street 1:437 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2223
Mailing Address - Country:US
Mailing Address - Phone:219-924-2044
Mailing Address - Fax:219-924-2109
Practice Address - Street 1:437 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2223
Practice Address - Country:US
Practice Address - Phone:219-924-2044
Practice Address - Fax:219-924-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN80000142OtherBC/BS HMO IL
IN000000097284OtherANTHEM BC/BS
IN0257340001Medicare ID - Type Unspecified