Provider Demographics
NPI:1033325428
Name:O.R.R.M.D., INC.
Entity Type:Organization
Organization Name:O.R.R.M.D., INC.
Other - Org Name:MUSKINGUM PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTHELLO
Authorized Official - Middle Name:R
Authorized Official - Last Name:REPUYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-7119
Mailing Address - Street 1:3814 JAMES CT
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0965
Mailing Address - Country:US
Mailing Address - Phone:740-454-7119
Mailing Address - Fax:740-455-5155
Practice Address - Street 1:3814 JAMES CT
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0965
Practice Address - Country:US
Practice Address - Phone:740-454-7119
Practice Address - Fax:740-455-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041605261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2365828Medicaid