Organization
KEYSTONE ORTHOPEDIC SPECIALISTS S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN HALL (OWNER)
(708) 799-1144
Entity
Organization
Contact information
Practice address
3330 WEST 177TH ST, SUITE 2C, HAZEL CREST, IL 60429
(708) 799-1144
(708) 799-4899
Mailing address
3330 WEST 177TH ST, SUITE 2C, HAZEL CREST, IL 60429
(708) 799-1144
(708) 799-4899
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
036074003
IL
213E00000X
Podiatrist
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095658
BCBS
IN
01
—
01620925
BCBS
IL
01
—
367659000
DEPT OF LABOR
—
01
—
CE8619
RAILROAD MEDICARE
IL
01
—
CE8620
RAILROAD MEDICARE
IN
Enumeration date
04/05/2006
Last updated
08/18/2016
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