Provider Demographics
NPI:1760148357
Name:OHIO SPORTS & SPINE INSTITUTE, LTD
Entity Type:Organization
Organization Name:OHIO SPORTS & SPINE INSTITUTE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KLEEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-9400
Mailing Address - Street 1:16844 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-4277
Mailing Address - Country:US
Mailing Address - Phone:330-386-6500
Mailing Address - Fax:
Practice Address - Street 1:16844 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-4277
Practice Address - Country:US
Practice Address - Phone:330-386-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty