Healthcare Provider Details

I. General information

NPI: 1386735371
Provider Name (Legal Business Name): BOWLING GREEN ORTHOPAEDICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 RIDGEWOOD DR STE A
BOWLING GREEN OH
43402-2694
US

IV. Provider business mailing address

1215 RIDGEWOOD DR STE A
BOWLING GREEN OH
43402-2694
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-1519
  • Fax: 419-352-7004
Mailing address:
  • Phone: 419-352-1519
  • Fax: 419-352-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MERRILL GLADDEN
Title or Position: PRESIDENT
Credential: MD
Phone: 419-352-1519