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Organization

ORTHOPEDICS OF SOUTH CENTRAL INDIANA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL CRAIG (CFO)
(812) 353-9554
Entity
Organization

Contact information

Practice address
583 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5515
(812) 333-2663
(812) 333-8140
Mailing address
583 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5515
(812) 353-6091

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
207QS0010X
Sports Medicine (Family Medicine) Physician
207X00000X
Orthopaedic Surgery Physician
208100000X
Physical Medicine & Rehabilitation Physician
225100000X
Physical Therapist
2255A2300X
Athletic Trainer
225X00000X
Occupational Therapist
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000256995
BLUE CROSS BLUE SHIELD
IN
05
200410200A
IN
01
CK6083
RAILROAD MEDICARE
IN
Enumeration date
06/21/2006
Last updated
02/15/2018
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