Provider Demographics
NPI:1538156427
Name:STEUBENVILLE ORTHOPEDICS & SPORTS MEDICINE, INC.
Entity type:Organization
Organization Name:STEUBENVILLE ORTHOPEDICS & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-283-2062
Mailing Address - Street 1:PO BOX 3144
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-7144
Mailing Address - Country:US
Mailing Address - Phone:740-282-2576
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHNSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2356
Practice Address - Country:US
Practice Address - Phone:740-283-2062
Practice Address - Fax:740-283-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070678207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306172Medicaid
WV0098397000Medicaid
WV0098397000Medicaid
OHG38229Medicare UPIN