Healthcare Provider Details

I. General information

NPI: 1972577245
Provider Name (Legal Business Name): FIDELITY ORTHOPEDIC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 MONARCH CT SUITE 110
WEST CHESTER OH
45069-2497
US

IV. Provider business mailing address

8514 N MAIN ST
DAYTON OH
45415-1325
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-6095
  • Fax: 513-779-4958
Mailing address:
  • Phone: 937-228-0682
  • Fax: 937-228-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. HILMO HODZIC
Title or Position: PRESIDENT
Credential: CP
Phone: 937-228-0682