Provider Demographics
NPI:1760551980
Name:BONE & JOINT SURGEONS, LTD
Entity Type:Organization
Organization Name:BONE & JOINT SURGEONS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANADAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-479-4681
Mailing Address - Street 1:11243 W LA PORTE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1374
Mailing Address - Country:US
Mailing Address - Phone:708-479-4681
Mailing Address - Fax:708-479-8516
Practice Address - Street 1:11243 W LA PORTE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1374
Practice Address - Country:US
Practice Address - Phone:708-479-4681
Practice Address - Fax:708-479-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE69083Medicare UPIN
ILF44317Medicare UPIN
IL206849Medicare ID - Type Unspecified
ILD14162Medicare UPIN
IL206852Medicare ID - Type Unspecified
IL206850Medicare ID - Type Unspecified