MEDICARE: ORTHOPEDIC ASSOC OF SPRINGFIELD 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000006848	OTHER	ANTHEM
2	0920049	OTHER	UNITED HEALTH CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720046733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC ASSOC OF SPRINGFIELD INC

Provider Business Mailing Address
First Line	:	1822 N LIMESTONE ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2628
Country	:	US
Telephone Number	:	937-399-7831
Fax Number	:	937-399-3731

Provider Business Practice Location Address
First Line	:	1822 N LIMESTONE ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2628
Country	:	US
Telephone Number	:	937-399-7831
Fax Number	:	937-399-3731

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NOSHIR E DEBOO
Credential	:	MD
Telephone Number	:	937-399-7831

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/20/2012

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