Provider Demographics
NPI:1346225547
Name:UNIVERSITY ORTHOPAEDIC PHYSICIANS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY ORTHOPAEDIC PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-487-8807
Mailing Address - Street 1:1335 DUBLIN RD
Mailing Address - Street 2:SUITE 110-E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1000
Mailing Address - Country:US
Mailing Address - Phone:614-487-8807
Mailing Address - Fax:614-487-8655
Practice Address - Street 1:1335 DUBLIN RD
Practice Address - Street 2:SUITE 110-E
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1000
Practice Address - Country:US
Practice Address - Phone:614-487-8807
Practice Address - Fax:614-487-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2124589Medicaid
OHUN9303331Medicare ID - Type Unspecified