Provider Demographics
NPI:1780874370
Name:JOSEPH ORTHOPEDIC SURGERY, P.A.
Entity type:Organization
Organization Name:JOSEPH ORTHOPEDIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-385-1788
Mailing Address - Street 1:1808 SHERMAN DR STE 2203
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1043
Mailing Address - Country:US
Mailing Address - Phone:812-385-1788
Mailing Address - Fax:812-385-1787
Practice Address - Street 1:1808 SHERMAN DR STE 2203
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1043
Practice Address - Country:US
Practice Address - Phone:812-385-1788
Practice Address - Fax:812-385-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061734A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH53571OtherUPIN
INH53571OtherUPIN