1477523587 NPI number — GAITWELL ORTHOTICS AND PEDORTHICS

Table of content: (NPI 1477523587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477523587 NPI number — GAITWELL ORTHOTICS AND PEDORTHICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAITWELL ORTHOTICS AND PEDORTHICS
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:
1477523587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 NORH COMMERCE PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45215-3188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-829-2217
Provider Business Mailing Address Fax Number:
513-889-1850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 WASHINGTON JACKSON RD
Provider Second Line Business Practice Location Address:
STE V
Provider Business Practice Location Address City Name:
EATON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45320-8627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-456-4800
Provider Business Practice Location Address Fax Number:
513-889-1850
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEDER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-456-4800

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X , with the licence number:  LO144 , 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: ========= . This is a "HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "TRICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0 . This is a "STRATOSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "HEALTHSPAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2389384 . This is a "BCMH MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2389384 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "PPOM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000298877 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200509680A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0 . This is a "HEALTHSMART NETWORK" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "MMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: A 146591 . This is a "MULTI PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "OH BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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