Provider Demographics
NPI:1386965044
Name:ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-415-9100
Mailing Address - Street 1:4160 LITTLE YORK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5800
Mailing Address - Country:US
Mailing Address - Phone:937-428-0400
Mailing Address - Fax:
Practice Address - Street 1:7677 YANKEE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3475
Practice Address - Country:US
Practice Address - Phone:937-415-9100
Practice Address - Fax:937-415-9191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4370207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2831305Medicaid
9374981Medicare PIN