Provider Demographics
NPI:1427279439
Name:ORTHOPEDIC ASSOCIATES OF NORTHERN OH INC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF NORTHERN OH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:216-367-1850
Mailing Address - Street 1:3645 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5247
Mailing Address - Country:US
Mailing Address - Phone:216-367-1850
Mailing Address - Fax:216-429-5067
Practice Address - Street 1:4100 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WARRENSVILLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-367-1850
Practice Address - Fax:216-295-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003905207X00000X
OH34002797207X00000X
OH34002641207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0483061Medicaid
OH9252151Medicare PIN
OH9252153Medicare PIN
OH9252158Medicare PIN
OH0483061Medicaid