Provider Demographics
NPI:1871922799
Name:NORTHERN INDIANA ORTHOPAEDIC SPECIALTY ASSOCIATES, PC
Entity type:Organization
Organization Name:NORTHERN INDIANA ORTHOPAEDIC SPECIALTY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-968-2832
Mailing Address - Street 1:6301 UNIVERSITY COMMONS STE 420
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1416
Mailing Address - Country:US
Mailing Address - Phone:574-968-2832
Mailing Address - Fax:574-968-2835
Practice Address - Street 1:6301 UNIVERSITY COMMONS STE 420
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1416
Practice Address - Country:US
Practice Address - Phone:574-968-2832
Practice Address - Fax:574-968-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038212A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty