Provider Demographics
NPI:1528109873
Name:ORTHOPEDIC ASSOCIATES OF SOUTHWESTERN OHIO, INC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF SOUTHWESTERN OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DICICCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-415-9100
Mailing Address - Street 1:4160 LITTLE YORK RD
Mailing Address - Street 2:STE. 10
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5800
Mailing Address - Country:US
Mailing Address - Phone:937-415-9100
Mailing Address - Fax:937-415-9191
Practice Address - Street 1:5300 FAR HILLS AVE
Practice Address - Street 2:STE. 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2381
Practice Address - Country:US
Practice Address - Phone:937-439-5503
Practice Address - Fax:937-439-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9257471Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER