Provider Demographics
NPI:1801345343
Name:INDIANA XPRESS ORTHO CARE, LLC
Entity type:Organization
Organization Name:INDIANA XPRESS ORTHO CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-255-3670
Mailing Address - Street 1:875 JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1920
Mailing Address - Country:US
Mailing Address - Phone:219-440-1006
Mailing Address - Fax:219-627-9802
Practice Address - Street 1:875 JOLIET ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1920
Practice Address - Country:US
Practice Address - Phone:219-440-1006
Practice Address - Fax:219-627-9802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:XPRESS ORTHO CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty