MEDICARE: ORTHOPAEDIC SPINE & JOINT CENTER

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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1417806134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC SPINE & JOINT CENTER

Provider Business Mailing Address
First Line	:	17825 CRADLER TURNER RD
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-9336
Country	:	US
Telephone Number	:	937-707-4662
Fax Number	:	614-573-0530

Provider Business Practice Location Address
First Line	:	1 CHASE CORPORATE DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1026
Country	:	US
Telephone Number	:	937-707-4662
Fax Number	:	614-573-0530

Authorized Official
Title or Position	:	CEO
Name	:	HEATHER GORE
Credential	:
Telephone Number	:	937-707-4662

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ORTHOPAEDIC SPINE & JOINT CENTER ” Practice Location

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