MEDICARE: ORTHOPAEDICS & SPORTS MEDICINE OF OHIO, LLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1255572749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDICS & SPORTS MEDICINE OF OHIO, LLC

Provider Business Mailing Address
First Line	:	17777 BRITTANY WOODS DR
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-5533
Country	:	US
Telephone Number	:	216-514-9590
Fax Number	:	216-514-9592

Provider Business Practice Location Address
First Line	:	23121 EMERY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5136
Country	:	US
Telephone Number	:	216-292-6766
Fax Number	:	216-292-6761

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL MYRON DIXON
Credential	:
Telephone Number	:	330-514-9590

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	03/13/2009

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