Provider Demographics
NPI:1710983200
Name:ORTHOPEDIC SPECIALISTS & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS & SPORTS MEDICINE, INC.
Other - Org Name:ORTHOPEDIC SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WESTERHEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-788-9220
Mailing Address - Street 1:2750 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9142
Mailing Address - Country:US
Mailing Address - Phone:740-788-9220
Mailing Address - Fax:740-788-9226
Practice Address - Street 1:2750 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9142
Practice Address - Country:US
Practice Address - Phone:740-788-9220
Practice Address - Fax:740-788-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1312580002Medicare NSC
OH9306771Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #