Healthcare Provider Details

I. General information

NPI: 1093449985
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF SW OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 EMMANUEL WAY STE A
SPRINGFIELD OH
45502-7218
US

IV. Provider business mailing address

PO BOX 713130
CINCINNATI OH
45271-3130
US

V. Phone/Fax

Practice location:
  • Phone: 800-824-9861
  • Fax:
Mailing address:
  • Phone: 937-415-9100
  • 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 MANAGER
Credential:
Phone: 937-415-9100