Provider Demographics
NPI:1801929724
Name:SPECIALTY ORTHOPEDICS INC
Entity type:Organization
Organization Name:SPECIALTY ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCPHERRON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-935-9395
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-5507
Mailing Address - Country:US
Mailing Address - Phone:574-935-9395
Mailing Address - Fax:574-935-0080
Practice Address - Street 1:2855 MILLER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8091
Practice Address - Country:US
Practice Address - Phone:574-935-9395
Practice Address - Fax:574-935-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2002777260Medicaid
IN4323240001Medicare NSC
IN2002777260Medicaid