MEDICARE: GAITWELL ORTHOTICS AND PEDORTHICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	LO144	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER	OH	HEALTHSMART NETWORK
2	A146591	OTHER	OH	MULTIPLAN
3	0	OTHER	OH	STRATOSE
4	000000298877	OTHER	OH	ANTHEM BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215032669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAITWELL ORTHOTICS AND PEDORTHICS

Provider Business Mailing Address
First Line	:	1 N COMMERCE PARK DR STE 306
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-3188
Country	:	US
Telephone Number	:	513-829-2217
Fax Number	:	513-889-1850

Provider Business Practice Location Address
First Line	:	1 N COMMERCE PARK DR
Second Line	:	SUITE 306
City	:	CINCINNATI
State	:	OH
Zip	:	45215-3187
Country	:	US
Telephone Number	:	513-829-2217
Fax Number	:	513-889-1850

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL D VEDER
Credential	:	CO, CPED
Telephone Number	:	937-456-4800

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/18/2020

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Directions to “GAITWELL ORTHOTICS AND PEDORTHICS ” Practice Location

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