Organization
ORTHOPAEDICS NORTHEAST PC
Active
Organization
ORTHOPAEDICS NORTHEAST PC
Active
Other names
DBA ONE Anesthesia Services
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA J HATHAWAY (CREDENTIALING OFFICER)
(260) 408-2203
Entity
Organization
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 490-6996
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054960
—
IN
05
—
100274410
—
IN
01
—
490001781
RAIL RAOD MEDICARE SURG
IN
01
—
CC5427
RAILROAD MEDICARE
IN
01
—
CI5112
RAIL ROAD MEDICARE
IN
01
—
CK0104
RAIL ROAD MEDICARE
IN
Enumeration date
01/09/2006
Last updated
05/12/2017
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