Provider Demographics
NPI:1639172745
Name:TRI COUNTY ORTHOPEDIC SURGEONS INCORPORATED
Entity type:Organization
Organization Name:TRI COUNTY ORTHOPEDIC SURGEONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:MORETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-837-8391
Mailing Address - Street 1:3244 BAILEY ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3616
Mailing Address - Country:US
Mailing Address - Phone:330-837-8391
Mailing Address - Fax:330-837-2221
Practice Address - Street 1:3244 BAILEY ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3616
Practice Address - Country:US
Practice Address - Phone:330-837-8391
Practice Address - Fax:330-837-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4160207XS0117X
OH36-003415213ES0103X
OH3505207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2599068Medicaid
OH0817772Medicaid
OH4160OtherJEFFREY COCHRAN LICENSE
OH3505OtherDANIEL MORETTA LICENSE
OH0530956Medicaid
OH0242437Medicaid
OH36003415OtherLICENSE
OH0530956Medicaid
OH3505OtherDANIEL MORETTA LICENSE
OH9911892Medicare ID - Type UnspecifiedCORPORATION
OH0687601Medicare ID - Type UnspecifiedJEFFREY M. COCHRAN, DO
OH0280150001Medicare NSC
OH0817772Medicaid
OH36003415OtherLICENSE
OH2599068Medicaid