Basic Information
| Provider Information | |||||||||
| NPI: | 1063566693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPER VALLEY ORTHOPAEDICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 TROY TOWN DR | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453732328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373353561 | ||||||||
| FaxNumber: | 9373391213 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 TROY TOWN DR | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453732328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373353561 | ||||||||
| FaxNumber: | 9373391213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | DELCAMP | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9373353561 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 0317740001 | OH | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0780525 | 05 | OH | MEDICAID | 000000015222 | 01 | OH | ANTHEM GROUP NUMBER | OTHER |