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General NPI Number Information
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NPI Number | 1467373092
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Entity Type | Organization
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Legal Business Name | RENOVO ORTHOPEDICS & SPINE LLC
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 300 ALLEN BRADLEY DR STE 250
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-6130
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Country | US
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Telephone | 717-691-6768
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ALLEN BRADLEY DR STE 250
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-6130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MITCHELL BASS
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Credential |
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Telephone | 717-691-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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