Provider Demographics
NPI:1962519561
Name:FAR OAKS ORTHOPEDISTS
Entity type:Organization
Organization Name:FAR OAKS ORTHOPEDISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STAVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLEINHENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-433-1336
Mailing Address - Street 1:6490 CENTERVILLE BUSINESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-433-1336
Mailing Address - Fax:937-433-1340
Practice Address - Street 1:450 NORTH HYATT
Practice Address - Street 2:SUITE 306
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371
Practice Address - Country:US
Practice Address - Phone:937-433-1336
Practice Address - Fax:937-433-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC5010OtherMEDICARE RAILROAD
OH0379399Medicaid
OH0379399Medicaid
OHDC5010OtherMEDICARE RAILROAD