Provider Demographics
NPI:1891882759
Name:SEYMOUR ORTHOPEDICS AND REHABILITATION LLC
Entity Type:Organization
Organization Name:SEYMOUR ORTHOPEDICS AND REHABILITATION LLC
Other - Org Name:SEYMOUR ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-524-3311
Mailing Address - Street 1:225 S PINE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2365
Mailing Address - Country:US
Mailing Address - Phone:812-524-3311
Mailing Address - Fax:812-524-3310
Practice Address - Street 1:225 S PINE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2365
Practice Address - Country:US
Practice Address - Phone:812-524-3311
Practice Address - Fax:812-524-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039941207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200192940Medicaid
IN200032328OtherMEDICARE RAILROAD
IN200192940Medicaid
IN1184625758Medicare NSC
IN382010Medicare ID - Type Unspecified