Healthcare Provider Details

I. General information

NPI: 1720046733
Provider Name (Legal Business Name): ORTHOPEDIC ASSOC OF SPRINGFIELD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 N LIMESTONE ST
SPRINGFIELD OH
45503-2628
US

IV. Provider business mailing address

1822 N LIMESTONE ST
SPRINGFIELD OH
45503-2628
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-7831
  • Fax: 937-399-3731
Mailing address:
  • Phone: 937-399-7831
  • Fax: 937-399-3731

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: DR. NOSHIR E DEBOO
Title or Position: PRESIDENT
Credential: MD
Phone: 937-399-7831