Provider Demographics
NPI:1073077590
Name:SPICER ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:SPICER ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:LP, COA
Authorized Official - Phone:330-904-9156
Mailing Address - Street 1:1830 RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8512
Mailing Address - Country:US
Mailing Address - Phone:330-904-9156
Mailing Address - Fax:330-595-1051
Practice Address - Street 1:11237 FAIROAKS RD NE STE B
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-8767
Practice Address - Country:US
Practice Address - Phone:330-595-1010
Practice Address - Fax:330-595-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier