=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710203534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC ONE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2010
-----------------------------------------------------
Last Update Date | 05/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 W CHERRY ST
-----------------------------------------------------
City | SUNBURY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43074-8011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-839-2300
-----------------------------------------------------
Fax | 614-839-2301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 170 TAYLOR STATION RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213-4491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-545-7900
-----------------------------------------------------
Fax | 614-545-7901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JOEL POLITI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 614-545-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 35-07-8203-W
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------