Provider Demographics
NPI:1851365472
Name:FIDELITY ORTHOPEDIC INC
Entity Type:Organization
Organization Name:FIDELITY ORTHOPEDIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-228-0682
Mailing Address - Street 1:8514 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1325
Mailing Address - Country:US
Mailing Address - Phone:937-228-0682
Mailing Address - Fax:937-228-8193
Practice Address - Street 1:7677 YANKEE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3475
Practice Address - Country:US
Practice Address - Phone:937-435-7041
Practice Address - Fax:937-228-8193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIDELITY ORTHOPEDIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307417Medicaid
OH0258640007Medicare PIN