Provider Demographics
NPI:1073794590
Name:OHIO ORTHOPEDIC SERVICES
Entity Type:Organization
Organization Name:OHIO ORTHOPEDIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-355-1004
Mailing Address - Street 1:1442 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4061
Mailing Address - Country:US
Mailing Address - Phone:419-355-1004
Mailing Address - Fax:
Practice Address - Street 1:1442 E STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4061
Practice Address - Country:US
Practice Address - Phone:419-355-1004
Practice Address - Fax:419-355-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP.82335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156352Medicaid
OH5257300001Medicare NSC