1447422118 NPI number — ORTHOPEDIC ASSOCIATES OF SW OHIO, INC

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 1447422118 NPI number — ORTHOPEDIC ASSOCIATES OF SW OHIO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC ASSOCIATES OF SW OHIO, INC
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:
1447422118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713130
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:
45271-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-415-9100
Provider Business Mailing Address Fax Number:
937-415-9191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 LITTLE YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45414-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-415-9100
Provider Business Practice Location Address Fax Number:
937-415-9191
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAYMAN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
937-415-9100

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DN6188 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2831305 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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