Provider Demographics
NPI:1962487470
Name:ORTHOPAEDIC & SPORTS MEDICINE CONSULTANTS INC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPORTS MEDICINE CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAGONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-424-7711
Mailing Address - Street 1:275 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3807
Mailing Address - Country:US
Mailing Address - Phone:513-424-7711
Mailing Address - Fax:513-424-3599
Practice Address - Street 1:275 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3807
Practice Address - Country:US
Practice Address - Phone:513-424-7711
Practice Address - Fax:513-424-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0506456Medicaid
OH0506456Medicaid
OH0437090001Medicare NSC