Provider Demographics
NPI:1922292663
Name:MCHENRY COUNTY ORTHOPAEDICS, S.C.
Entity Type:Organization
Organization Name:MCHENRY COUNTY ORTHOPAEDICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MANETTE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DECREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-788-2018
Mailing Address - Street 1:420 N IL ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3711
Mailing Address - Country:US
Mailing Address - Phone:815-356-5200
Mailing Address - Fax:815-356-5262
Practice Address - Street 1:420 N IL ROUTE 31
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3711
Practice Address - Country:US
Practice Address - Phone:815-356-5200
Practice Address - Fax:815-356-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5619608OtherBLUE SHIELD GROUP NUMBER
IL339540Medicare PIN
IL1062020001Medicare NSC
IL210744Medicare PIN
ILCG1420Medicare PIN