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General NPI Number Information
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NPI Number | 1174627889
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Entity Type | Organization
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Legal Business Name | TRISTATE ORTHOPAEDIC TREATMENT CENTER, INC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 10547 MONTGOMERY RD SUITE 400
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City | CINCINNATI
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State | OH
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Zip | 45242-4418
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Country | US
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Telephone | 513-791-6611
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Fax | 513-791-6788
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Provider Business Mailing Address
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Address Line | 10547 MONTGOMERY RD SUITE 400
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City | CINCINNATI
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State | OH
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Zip | 45242-4418
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Country | US
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Telephone | 513-791-6611
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Fax | 513-791-6788
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLYDE E HENDERSON
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Credential | MD
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Telephone | 513-791-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | OH
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