Provider Demographics
NPI:1912924937
Name:NORTHWEST BONE AND JOINT, PC
Entity Type:Organization
Organization Name:NORTHWEST BONE AND JOINT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:MOULTRIE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:219-793-9029
Mailing Address - Street 1:255 E 90TH DR
Mailing Address - Street 2:SUITE W1
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8103
Mailing Address - Country:US
Mailing Address - Phone:219-793-9029
Mailing Address - Fax:219-738-6716
Practice Address - Street 1:55 E 86TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6382
Practice Address - Country:US
Practice Address - Phone:219-769-1670
Practice Address - Fax:219-738-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234530Medicare ID - Type Unspecified