# MIDWEST ORTHOPAEDIC INSTITUTE P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Midwest Orthopaedic Institute SC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013976927
- **Authorized official:** ASHLEY ROSS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (815) 991-2333

## Contact information

- **Practice address:** 2111 MIDLANDS COURT, SYCAMORE, IL 60178
- **Practice address phone:** (815) 758-0000
- **Practice address fax:** (815) 758-0094
- **Mailing address:** 1952 ABERDEEN CT, SYCAMORE, IL 60178-3175
- **Mailing address phone:** (815) 758-0000
- **Mailing address fax:** (815) 748-3014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RR0500X | Rheumatology Physician | — | NULL | — |
| 207RR0500X | Rheumatology Physician | — | — | — |
| 207T00000X | Neurological Surgery Physician | — | NULL | — |
| 207T00000X | Neurological Surgery Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | NULL | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | 060010536 | IL | — |
| 261QR0400X | Rehabilitation Clinic/Center | 060010536 | IL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 060010536 | IL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 060010536 | IN | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 03/20/2006
- **Last updated:** 08/29/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 041032 | HEALTH ALLIANCE | IL |
| 01 | — | 1915167 | BLUE CROSS/BLUE SHIELD | IL |