# ORTHOPEDIC SPECIALISTS SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427123926
- **Authorized official:** MS. KELLY PANCAMO (BILLING SUPERVISOR)
- **Authorized official phone:** (630) 333-4447

## Contact information

- **Practice address:** 675 W NORTH AVE, SUITE314, MELROSE PARK, IL 60160-1634
- **Practice address phone:** (630) 782-9600
- **Practice address fax:** (630) 782-1643
- **Mailing address:** 360 W BUTTERFIELD ROAD, SUITE160, ELMHURST, IL 60126
- **Mailing address phone:** (630) 782-9600
- **Mailing address fax:** (630) 782-1643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016005007 | IL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 02/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02222323 | BCBS | IL |