Healthcare Provider Details

I. General information

NPI: 1609387984
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF S W OHIO INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 01/06/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 RAINBOW CT
FAIRBORN OH
45324-6365
US

IV. Provider business mailing address

4160 LITTLE YORK RD STE 10
DAYTON OH
45414-5803
US

V. Phone/Fax

Practice location:
  • Phone: 800-824-9861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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