Organization
ASCENDANT ORTHOPEDIC ALLIANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN R YEARY (DIRECTOR OF BILLING)
(574) 247-6583
Entity
Organization
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300009135
—
IN
Enumeration date
08/16/2017
Last updated
09/02/2020
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