Provider Demographics
NPI:1043046394
Name:MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
Entity type:Organization
Organization Name:MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-325-4589
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-1297
Mailing Address - Country:US
Mailing Address - Phone:262-710-3862
Mailing Address - Fax:626-581-4004
Practice Address - Street 1:W189S7793 RACINE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9546
Practice Address - Country:US
Practice Address - Phone:262-710-3862
Practice Address - Fax:626-581-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation