Provider Demographics
NPI:1023203015
Name:MID OHIO ORTHOPAEDIC SURGERY & SPORTS MEDICINE INC
Entity type:Organization
Organization Name:MID OHIO ORTHOPAEDIC SURGERY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOLODZIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-228-2808
Mailing Address - Street 1:51 S SOUDER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1548
Mailing Address - Country:US
Mailing Address - Phone:614-228-2808
Mailing Address - Fax:614-221-0079
Practice Address - Street 1:51 S SOUDER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1548
Practice Address - Country:US
Practice Address - Phone:614-228-2808
Practice Address - Fax:614-221-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9217011Medicare PIN