1912205071 NPI number — ORTHOPEDIC ASSOCIATES OF S W OHIO INC,

Table of content: MRS. CAROL ANN DICESARE RN (NPI 1194029199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912205071 NPI number — ORTHOPEDIC ASSOCIATES OF S W OHIO INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC ASSOCIATES OF S W 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:
1912205071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2012
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:
45271-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-415-9100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45415-1180
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:
Provider Enumeration Date:
03/14/2011

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




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