Provider Demographics
NPI:1740720325
Name:OHIO MUSCULOSKELETAL SPORTS AND SPINE
Entity type:Organization
Organization Name:OHIO MUSCULOSKELETAL SPORTS AND SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EAKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-369-4933
Mailing Address - Street 1:2136 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1832
Mailing Address - Country:US
Mailing Address - Phone:973-369-4933
Mailing Address - Fax:
Practice Address - Street 1:320 ALBANY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3402
Practice Address - Country:US
Practice Address - Phone:937-496-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID