1235302597 NPI number — MIAMI ORTHOPAEDICS & SPORTS MEDICINE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235302597 NPI number — MIAMI ORTHOPAEDICS & SPORTS MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAMI ORTHOPAEDICS & SPORTS MEDICINE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235302597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 643386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45264-3386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-889-2554
Provider Business Mailing Address Fax Number:
513-889-2557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3035 HAMILTON MASON RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45011-5307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-889-2554
Provider Business Practice Location Address Fax Number:
513-889-2557
Provider Enumeration Date:
04/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
513-889-2554

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  35084628 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DO0271 . This is a "MEDICARE RR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2840537 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".