Healthcare Provider Details

I. General information

NPI: 1952879363
Provider Name (Legal Business Name): ORTHOPAEDIC INSTITUTE OF OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ST LAWRENCE DR STE 102
TIFFIN OH
44883-8313
US

IV. Provider business mailing address

801 MEDICAL DR STE A
LIMA OH
45804-4030
US

V. Phone/Fax

Practice location:
  • Phone: 419-448-7424
  • Fax:
Mailing address:
  • Phone: 419-222-6622
  • Fax: 419-224-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KATHLYNN L ACKERMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 419-222-6622