1235302597 NPI number — MIAMI ORTHOPAEDICS & SPORTS MEDICINE, LLC

Table of content: (NPI 1235302597)

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".