Provider Demographics
NPI:1750577656
Name:CINCINNATI SPORTSMEDICINE AND ORTHOPAEDIC CENTER, INC.
Entity type:Organization
Organization Name:CINCINNATI SPORTSMEDICINE AND ORTHOPAEDIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-792-3233
Mailing Address - Street 1:10663 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-792-3230
Practice Address - Street 1:6350 GLENWAY AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6378
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-347-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0772669Medicaid
OH9927572Medicare PIN