MEDICARE: R J ROSENBERG ORTHOPEDIC LAB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	LPO99	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851345243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R J ROSENBERG ORTHOPEDIC LAB INC

Provider Business Mailing Address
First Line	:	3366 CENTRAL PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-2307
Country	:	US
Telephone Number	:	513-221-7200
Fax Number	:	513-221-7204

Provider Business Practice Location Address
First Line	:	3366 CENTRAL PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-2307
Country	:	US
Telephone Number	:	513-221-7200
Fax Number	:	513-221-7204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RYAN SPILL
Credential	:	CP, LP
Telephone Number	:	513-221-7200

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	11/17/2015

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