Healthcare Provider Details

I. General information

NPI: 1649428244
Provider Name (Legal Business Name): BONE & JOINT SURGEONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST
DAYTON OH
45415-1180
US

IV. Provider business mailing address

9000 N MAIN ST
DAYTON OH
45415-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-832-5599
  • Fax:
Mailing address:
  • Phone: 937-832-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: SHELLI POWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 937-832-5599