Provider Demographics
NPI:1881661106
Name:ORTHOPEDICS AND SPORTS MEDICINE INCORPORATED
Entity Type:Organization
Organization Name:ORTHOPEDICS AND SPORTS MEDICINE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LADU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-878-6182
Mailing Address - Street 1:165 N MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-878-6182
Mailing Address - Fax:614-878-1922
Practice Address - Street 1:165 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-878-6182
Practice Address - Fax:614-878-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22000000006233OtherANTHEM
0236730002OtherDMFRC
2026236OtherAETNA
22000000006232OtherANTHEM
0000572874OtherHIGHMARK BLUE SHIELD
OH0243374Medicaid
0652009OtherAETNA
0236730001OtherDMFRC
910760OtherHEALTH MAINTENANCE PLAN
=========000OtherAETNA
0236730002OtherDMFRC
OH0243374Medicaid
0236730001OtherDMFRC
2026236OtherAETNA
=========0006OtherAETNA
=========03OtherSTATE OF OH BUREAU OF WOR
OR9162901Medicare ID - Type Unspecified
=========01OtherSTATE OF OH BUREAU OF WOR
=========000OtherAETNA
OH0243374Medicaid