Provider Demographics
NPI:1811970858
Name:KNEE & SHOULDER CENTER, INC.
Entity type:Organization
Organization Name:KNEE & SHOULDER CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-497-8855
Mailing Address - Street 1:2510 E DUPONT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1600
Mailing Address - Country:US
Mailing Address - Phone:260-497-8855
Mailing Address - Fax:260-497-8866
Practice Address - Street 1:2510 E DUPONT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1600
Practice Address - Country:US
Practice Address - Phone:260-497-8855
Practice Address - Fax:260-497-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty