Provider Demographics
NPI:1376691055
Name:BONE & JOINT ORTHOPAEDICS, INC.
Entity Type:Organization
Organization Name:BONE & JOINT ORTHOPAEDICS, INC.
Other - Org Name:BONE & JOINT ORTHOPAEDICS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-432-2131
Mailing Address - Street 1:1175 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3059
Mailing Address - Country:US
Mailing Address - Phone:740-432-2131
Mailing Address - Fax:740-432-4162
Practice Address - Street 1:1175 S 13TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3059
Practice Address - Country:US
Practice Address - Phone:740-432-2131
Practice Address - Fax:740-432-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038605R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2179342Medicaid
OH2179342Medicaid
OH9338821Medicare ID - Type Unspecified