Provider Demographics
NPI:1740313071
Name:ATLAS ORTHOPEDICS & SPORTS MEDICINE INC PC
Entity type:Organization
Organization Name:ATLAS ORTHOPEDICS & SPORTS MEDICINE INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-920-7432
Mailing Address - Street 1:3660 GUION RD STE 230
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1691
Mailing Address - Country:US
Mailing Address - Phone:317-920-7432
Mailing Address - Fax:317-920-7446
Practice Address - Street 1:3660 GUION RD STE 230
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1691
Practice Address - Country:US
Practice Address - Phone:317-920-7432
Practice Address - Fax:317-920-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty