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Contact Information

MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
3740 EDISON LAKES PKWY
MISHAWAKA, IN46545-3474
 Phone: 574-252-4150
 Fax: 574-252-4159
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

2081P2900X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC

NPI # 1912074659
LBN Legal business name MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
Authorized official KEVIN DREW - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 11/29/2006
Last updated 11/03/2022 - About 4 years ago
Identifiers
IN License # 01042863
IN Medicaid 200216220A
Other 129646400 DEPT OF LABORACS
Other CI5205 RAILROAD MEDICARE
MI Other 25-0A110370 BCBSMI
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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