Healthcare Provider Details

I. General information

NPI: 1962487470
Provider Name (Legal Business Name): ORTHOPAEDIC & SPORTS MEDICINE CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

IV. Provider business mailing address

275 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-7711
  • Fax: 513-424-3599
Mailing address:
  • Phone: 513-424-7711
  • Fax: 513-424-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35050466
License Number StateOH

VIII. Authorized Official

Name: DR. JERRY B MAGONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-424-7711