Provider Demographics
NPI:1720046733
Name:ORTHOPEDIC ASSOC OF SPRINGFIELD INC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOC OF SPRINGFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOSHIR
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEBOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-399-7831
Mailing Address - Street 1:1822 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2628
Mailing Address - Country:US
Mailing Address - Phone:937-399-7831
Mailing Address - Fax:937-399-3731
Practice Address - Street 1:1822 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2628
Practice Address - Country:US
Practice Address - Phone:937-399-7831
Practice Address - Fax:937-399-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000006848OtherANTHEM
0920049OtherUNITED HEALTH CARE
OH0302256Medicaid
OH0302256Medicaid
000000006848OtherANTHEM