Provider Demographics
NPI:1992834584
Name:INTEGRATED ORTHOPEDICS, INC.
Entity Type:Organization
Organization Name:INTEGRATED ORTHOPEDICS, INC.
Other - Org Name:WABASH MEDICAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-744-1578
Mailing Address - Street 1:7750 ZIONSVILLE RD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5126
Mailing Address - Country:US
Mailing Address - Phone:317-704-3300
Mailing Address - Fax:317-704-3303
Practice Address - Street 1:7750 ZIONSVILLE RD
Practice Address - Street 2:SUITE 850
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-5126
Practice Address - Country:US
Practice Address - Phone:317-704-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000289A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200862830AMedicaid
1286200002Medicare NSC