Provider Demographics
NPI:1063566693
Name:UPPER VALLEY ORTHOPAEDICS INC
Entity type:Organization
Organization Name:UPPER VALLEY ORTHOPAEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-335-3561
Mailing Address - Street 1:76 TROY TOWN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2328
Mailing Address - Country:US
Mailing Address - Phone:937-335-3561
Mailing Address - Fax:937-339-1213
Practice Address - Street 1:76 TROY TOWN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2328
Practice Address - Country:US
Practice Address - Phone:937-335-3561
Practice Address - Fax:937-339-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0317740001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0780525Medicaid
OH000000015222OtherANTHEM GROUP NUMBER
OH0780525Medicaid
OH=========00OtherBWC GROUP NUMBER
OH000000015222OtherANTHEM GROUP NUMBER
OHUP9932141Medicare PIN