MEDICARE: ASHTABULA ORTHOPAEDICS, INC.

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	OH4336	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM3156	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1649250572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHTABULA ORTHOPAEDICS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1425
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44005-1425
Country	:	US
Telephone Number	:	440-997-6646
Fax Number	:	440-992-4238

Provider Business Practice Location Address
First Line	:	2131 LAKE AVE
Second Line	:	SUITE #1
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3466
Country	:	US
Telephone Number	:	440-997-6646
Fax Number	:	440-992-4238

Authorized Official
Title or Position	:	ORTHOPAEDIC SURGEON
Name	:	JEFFREY ALAN BRODSKY
Credential	:	D.O.
Telephone Number	:	440-997-6646

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/05/2008

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Directions to “ASHTABULA ORTHOPAEDICS, INC. ” Practice Location

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