Provider Demographics
NPI:1285622688
Name:ORTHOPEDIC TRAUMA SERVICES LTD
Entity type:Organization
Organization Name:ORTHOPEDIC TRAUMA SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REV. CYCLE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WUESTEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-544-6351
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:614-544-6356
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4354
Practice Address - Country:US
Practice Address - Phone:614-566-7777
Practice Address - Fax:614-566-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2571917Medicaid
OHOR9352981Medicare PIN