Provider Demographics
NPI:1588864938
Name:ORTHOCINCY
Entity type:Organization
Organization Name:ORTHOCINCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-817-7070
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-817-7500
Mailing Address - Fax:859-817-7851
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:SUITE 2600
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9864
Practice Address - Country:US
Practice Address - Phone:513-793-3933
Practice Address - Fax:513-793-8299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOCINCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00399980003OtherDURABLE MEDICAL EQUIPMENT
OH0202140Medicaid
OH0399980003Medicare NSC