Provider Demographics
NPI:1477523587
Name:GAITWELL ORTHOTICS AND PEDORTHICS
Entity Type:Organization
Organization Name:GAITWELL ORTHOTICS AND PEDORTHICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:VEDER
Authorized Official - Suffix:
Authorized Official - Credentials:CO, CPED
Authorized Official - Phone:937-456-4800
Mailing Address - Street 1:1 NORH COMMERCE PARK DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3188
Mailing Address - Country:US
Mailing Address - Phone:513-829-2217
Mailing Address - Fax:513-889-1850
Practice Address - Street 1:200 WASHINGTON JACKSON RD
Practice Address - Street 2:STE V
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8627
Practice Address - Country:US
Practice Address - Phone:937-456-4800
Practice Address - Fax:513-889-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLO144222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherHUMANA
OH=========OtherTRICARE
OH0OtherSTRATOSE
OH=========OtherHEALTHSPAN
OH2389384OtherBCMH MEDICAID
OH2389384Medicaid
OH=========OtherPPOM
OH000000298877OtherANTHEM BLUE CROSS
IN200509680AMedicaid
OH=========OtherCARESOURCE
OH0OtherHEALTHSMART NETWORK
OH=========OtherMMO
OHA 146591OtherMULTI PLAN
OH=========OtherOH BWC
IN200509680AMedicaid