Provider Demographics
NPI:1831239177
Name:ORTHOPEDIC & SPINE SURGERY ASSOC
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE SURGERY ASSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-5300
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-5300
Mailing Address - Fax:847-931-9072
Practice Address - Street 1:420 W NORTHWEST HWY
Practice Address - Street 2:SUITE M
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6837
Practice Address - Country:US
Practice Address - Phone:847-382-6766
Practice Address - Fax:847-382-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208821Medicare ID - Type UnspecifiedLAKE COUNTY GROUP
IL207906Medicare ID - Type UnspecifiedMCHENRY COUNTY GRP