Provider Demographics
NPI:1841439742
Name:ORTHOPEDIC & SPINE SURGERY ASSOCIATES LTD.
Entity type:Organization
Organization Name:ORTHOPEDIC & SPINE SURGERY ASSOCIATES LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
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:SUITE 800
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-2210
Mailing Address - Fax:847-931-2212
Practice Address - Street 1:420 W NORTHWEST HWY
Practice Address - Street 2:SUITE J
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6837
Practice Address - Country:US
Practice Address - Phone:847-382-6477
Practice Address - Fax:847-382-6478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC & SPINE SURGERY ASSOCIATES LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-17
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
208821Medicare Oscar/Certification