Provider Demographics
NPI:1720256472
Name:NORTHWEST ORTHOPEDIC SURGERY, S.C.
Entity Type:Organization
Organization Name:NORTHWEST ORTHOPEDIC SURGERY, S.C.
Other - Org Name:NORTHWEST REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-870-4200
Mailing Address - Street 1:1120 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4767
Mailing Address - Country:US
Mailing Address - Phone:847-870-4200
Mailing Address - Fax:847-870-0059
Practice Address - Street 1:1120 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4767
Practice Address - Country:US
Practice Address - Phone:847-870-4200
Practice Address - Fax:847-870-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42-3132207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL716160OtherMEDICARE PROVIDER NUMBER
IL716160OtherMEDICARE PROVIDER NUMBER