Provider Demographics
NPI:1770221897
Name:MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
Entity Type:Organization
Organization Name:MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
Other - Org Name:MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL PT
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3000
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-1153
Mailing Address - Country:US
Mailing Address - Phone:414-239-9547
Mailing Address - Fax:414-240-3592
Practice Address - Street 1:11415 W BURLEIGH ST STE 109
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3217
Practice Address - Country:US
Practice Address - Phone:414-239-9547
Practice Address - Fax:414-240-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation