1487739678 NPI number — ORTHOPEDIC ASSOCIATES OF NORTHERN OH

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 1487739678 NPI number — ORTHOPEDIC ASSOCIATES OF NORTHERN OH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC ASSOCIATES OF NORTHERN OH
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:
1487739678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3645 WARRENSVILLE CENTER RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
SHAKER HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-367-1850
Provider Business Mailing Address Fax Number:
216-295-0670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
863 W AURORA RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAGAMORE HILLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44067-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-367-1850
Provider Business Practice Location Address Fax Number:
216-295-0670
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
216-367-1850

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , 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: 0374710004 . This is a "ADMIN STAR" identifier . This identifiers is of the category "OTHER".




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