Provider Demographics
NPI:1972577245
Name:FIDELITY ORTHOPEDIC INCORPORATED
Entity Type:Organization
Organization Name:FIDELITY ORTHOPEDIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HILMO
Authorized Official - Middle Name:
Authorized Official - Last Name:HODZIC
Authorized Official - Suffix:
Authorized Official - Credentials:CP
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 1:7665 MONARCH CT
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2497
Practice Address - Country:US
Practice Address - Phone:513-777-6095
Practice Address - Fax:513-779-4958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIDELITY ORTHOPEDIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-14
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2106036Medicaid
OH2106036Medicaid