Provider Demographics
NPI:1669450961
Name:RIVER VALLEY ORTHOPAEDICS & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:RIVER VALLEY ORTHOPAEDICS & SPORTS MEDICINE, INC.
Other - Org Name:OHIO ORTHOPAEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-3346
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-687-3346
Mailing Address - Fax:740-689-9736
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-3346
Practice Address - Fax:740-689-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2023027Medicaid
OH2023027Medicaid