Provider Demographics
NPI:1982689337
Name:LIMA JOINT REPLACEMENT INC
Entity Type:Organization
Organization Name:LIMA JOINT REPLACEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:VANATTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-527-3872
Mailing Address - Street 1:PO BOX 76629
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-6500
Mailing Address - Country:US
Mailing Address - Phone:800-527-3872
Mailing Address - Fax:414-222-0384
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:800-527-3872
Practice Address - Fax:419-222-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040106207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528412Medicare PIN