Provider Demographics
NPI:1760492516
Name:ORTHOPAEDIC AND TRAUMA SURGEONS INC
Entity Type:Organization
Organization Name:ORTHOPAEDIC AND TRAUMA SURGEONS INC
Other - Org Name:OHIO ORTHOPEDIC CENTER OF EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-827-8700
Mailing Address - Street 1:4605 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2246
Mailing Address - Country:US
Mailing Address - Phone:614-827-8700
Mailing Address - Fax:614-827-8701
Practice Address - Street 1:4605 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-2246
Practice Address - Country:US
Practice Address - Phone:614-827-8700
Practice Address - Fax:614-827-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X, 208100000X, 225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231945Medicaid
OH0366640001Medicare NSC
OH9270851Medicare PIN