Provider Demographics
NPI:1932367315
Name:OHIO VALLEY ORTHOPAEDICS AND SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:OHIO VALLEY ORTHOPAEDICS AND SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-985-3700
Mailing Address - Street 1:8311 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2227
Mailing Address - Country:US
Mailing Address - Phone:513-985-3700
Mailing Address - Fax:513-985-3706
Practice Address - Street 1:8311 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2227
Practice Address - Country:US
Practice Address - Phone:513-985-3700
Practice Address - Fax:513-985-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH939079Medicaid
OH9935021Medicare UPIN