Provider Demographics
NPI:1477690329
Name:MARYSVILLE ORTHOPEDICS
Entity Type:Organization
Organization Name:MARYSVILLE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-578-4200
Mailing Address - Street 1:388 DAMASCUS RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-5535
Mailing Address - Country:US
Mailing Address - Phone:937-578-4200
Mailing Address - Fax:937-578-4323
Practice Address - Street 1:388 DAMASCUS RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5535
Practice Address - Country:US
Practice Address - Phone:937-578-4200
Practice Address - Fax:937-578-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9346971Medicare PIN