Provider Demographics
NPI:1134252240
Name:ORTHOPAEDIC ASSOCIATES OF HAMMOND, INC.
Entity type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF HAMMOND, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURCZYK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:219-836-0296
Mailing Address - Street 1:9034 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-0296
Mailing Address - Fax:219-836-0570
Practice Address - Street 1:9034 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-0296
Practice Address - Fax:219-836-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL91115486OtherBLUE CROSS BLUE SHIELD IL
=========OtherTRICARE
IN386960Medicare ID - Type UnspecifiedMEDICARE
IL91115486OtherBLUE CROSS BLUE SHIELD IL