Healthcare Provider Details

I. General information

NPI: 1639172745
Provider Name (Legal Business Name): TRI COUNTY ORTHOPEDIC SURGEONS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 BAILEY ST NW
MASSILLON OH
44646-3616
US

IV. Provider business mailing address

3244 BAILEY ST NW
MASSILLON OH
44646-3616
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-8391
  • Fax: 330-837-2221
Mailing address:
  • Phone: 330-837-8391
  • Fax: 330-837-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3505
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4160
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-003415
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL NEIL MORETTA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 330-837-8391