Provider Demographics
NPI:1134203490
Name:PUTNAM SURGICAL SPECIALTIES
Entity type:Organization
Organization Name:PUTNAM SURGICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODPASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-655-2671
Mailing Address - Street 1:1542 S BLOOMINGTON ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2212
Mailing Address - Country:US
Mailing Address - Phone:765-658-2710
Mailing Address - Fax:765-653-8686
Practice Address - Street 1:1542 S BLOOMINGTON ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2212
Practice Address - Country:US
Practice Address - Phone:765-658-2710
Practice Address - Fax:765-653-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty