1275722506 NPI number — ORTHOPEDIC ASSOCIATES OF S W OHIO, INC

Table of content: (NPI 1275722506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275722506 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:
1275722506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2012
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:
7700 WASHINGTON VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-433-3460
Provider Business Practice Location Address Fax Number:
937-433-2061
Provider Enumeration Date:
10/23/2007

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: 0300436 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2831305 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200014379 . This is a "MED RR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DN6188 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com