Provider Demographics
NPI:1689372328
Name:ORTHOSPINE MONITORING 2 LLC
Entity Type:Organization
Organization Name:ORTHOSPINE MONITORING 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISIO-ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-797-7463
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:855-864-4322
Mailing Address - Fax:219-310-8951
Practice Address - Street 1:1448 PARK WEST CIR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3976
Practice Address - Country:US
Practice Address - Phone:630-608-3298
Practice Address - Fax:219-310-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty