Provider Demographics
NPI:1114048444
Name:ORTHOPAEDIC INSTITUTE OF OHIO
Entity Type:Organization
Organization Name:ORTHOPAEDIC INSTITUTE OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-222-6622
Mailing Address - Street 1:801 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4099
Mailing Address - Country:US
Mailing Address - Phone:419-222-6622
Mailing Address - Fax:419-224-0015
Practice Address - Street 1:601 S.R. 224
Practice Address - Street 2:
Practice Address - City:GLANDORF
Practice Address - State:OH
Practice Address - Zip Code:45848
Practice Address - Country:US
Practice Address - Phone:419-226-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2030420Medicaid
OH2030420Medicaid