Provider Demographics
NPI:1508050485
Name:CENTRAL OHIO SPORTS MEDICINE AND ORTHOPEDICS INCORPORATED
Entity Type:Organization
Organization Name:CENTRAL OHIO SPORTS MEDICINE AND ORTHOPEDICS INCORPORATED
Other - Org Name:'COSMO'
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LADU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-878-6182
Mailing Address - Street 1:165 N MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1585
Mailing Address - Country:US
Mailing Address - Phone:614-878-6182
Mailing Address - Fax:614-878-1922
Practice Address - Street 1:165 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1585
Practice Address - Country:US
Practice Address - Phone:614-878-6182
Practice Address - Fax:614-878-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005826174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0671269Medicaid
294741914013OtherMEDICAL MUTUAL OF OHIO
DG8198OtherRAILROAD MEDICARE
000000543334OtherANTHEM
32054993301OtherMEDICAL MUTUAL OH OHIO
000000543295OtherANTHEM
000000543336OtherANTHEM
OH2024893Medicaid
PO0456788OtherRAILROAD MEDICARE
000000543304OtherANTHEM
121264245001OtherMEDICAL MUTUAL OF OHIO
OH0048095Medicaid
PO0456787OtherRAILROAD MEDICARE
PO0456789OtherRAILROAD MEDICARE
OH0048095Medicaid
D89838Medicare UPIN
000000543304OtherANTHEM
DG8198OtherRAILROAD MEDICARE
000000543336OtherANTHEM
OH0671269Medicaid