Provider Demographics
NPI:1205909066
Name:ORTHOPEDIC ASSOCIATES OF SHELBY COUNTY INC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF SHELBY COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-497-9810
Mailing Address - Street 1:1529 FAIR RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8193
Mailing Address - Country:US
Mailing Address - Phone:937-497-9810
Mailing Address - Fax:937-497-1334
Practice Address - Street 1:1529 FAIR RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8193
Practice Address - Country:US
Practice Address - Phone:937-497-9810
Practice Address - Fax:937-497-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964210Medicaid
OH0971499Medicaid
OH=========-00OtherBWC GROUP ID#
OH9230983Medicare ID - Type UnspecifiedSIDNEY GROUP MCARE#
OH0964210Medicaid