Provider Demographics
NPI:1386735371
Name:BOWLING GREEN ORTHOPAEDICS INC.
Entity type:Organization
Organization Name:BOWLING GREEN ORTHOPAEDICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-352-1519
Mailing Address - Street 1:1215 RIDGEWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2694
Mailing Address - Country:US
Mailing Address - Phone:419-352-1519
Mailing Address - Fax:419-352-7004
Practice Address - Street 1:1215 RIDGEWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2694
Practice Address - Country:US
Practice Address - Phone:419-352-1519
Practice Address - Fax:419-352-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495012Medicaid
OH10677OtherCHAMPUS GROUP ID#
OH0495012Medicaid
OH164600001Medicare NSC
OHCL9340Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
OHB09919931Medicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER