Healthcare Provider Details

I. General information

NPI: 1386965044
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 YANKEE ST SUITE 110
CENTERVILLE OH
45459-3475
US

IV. Provider business mailing address

4160 LITTLE YORK RD SUITE 10
DAYTON OH
45414-5800
US

V. Phone/Fax

Practice location:
  • Phone: 937-415-9100
  • Fax: 937-415-9191
Mailing address:
  • Phone: 937-428-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4370
License Number StateOH

VIII. Authorized Official

Name: ANGELA M LAYMAN
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 937-415-9100