Provider Demographics
NPI:1881613040
Name:SPECIALISTS IN ORTHOPEDIC SURGERY PLLC
Entity type:Organization
Organization Name:SPECIALISTS IN ORTHOPEDIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HATHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-937-3411
Mailing Address - Street 1:1 WILLIAM CARLS DR
Mailing Address - Street 2:RSC @ HVSH
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2201
Mailing Address - Country:US
Mailing Address - Phone:248-937-4947
Mailing Address - Fax:248-937-5150
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:RSC @ HVSH
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-4947
Practice Address - Fax:248-937-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37461OtherBCBSMI GROUP ID#
MI0F32656OtherBCBSMI DME SUPPLIER ID#
MI5606110OtherADMINISTAR FEDERAL DME
MI5606110003OtherADMINISTAR FEDERAL DME
MI5606110OtherADMINISTAR FEDERAL DME