Provider Demographics
NPI:1275722506
Name:ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-415-9100
Mailing Address - Street 1:PO BOX 713130
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:937-415-9100
Mailing Address - Fax:
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3953
Practice Address - Country:US
Practice Address - Phone:937-433-3460
Practice Address - Fax:937-433-2061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC ASSOCIATES OF S W OHIO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-23
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0300436Medicaid
OH2831305Medicaid
OH200014379OtherMED RR
OHDN6188OtherRR MEDICARE
OH0270380001Medicare NSC
OH200014379OtherMED RR
OH6366250007Medicare NSC
OHDN6188OtherRR MEDICARE
OH2831305Medicaid