Healthcare Provider Details

I. General information

NPI: 1700810819
Provider Name (Legal Business Name): CINCINNATI SPORTSMEDICINE AND ORTHOPAEDIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12115 SHERATON LN
CINCINNATI OH
45246-1613
US

IV. Provider business mailing address

10663 MONTGOMERY RD
CINCINNATI OH
45242-4403
US

V. Phone/Fax

Practice location:
  • Phone: 513-671-0311
  • Fax: 513-346-7299
Mailing address:
  • Phone: 513-347-9999
  • Fax: 513-792-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number999999
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number999999
License Number StateOH

VIII. Authorized Official

Name: FRANK R NOYES
Title or Position: DIRECTOR
Credential: M.D.
Phone: 513-347-9999