Basic Information
| Provider Information | |||||||||
| NPI: | 1083945638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 S LOOP RD | ||||||||
| Address2: | |||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598177500 | ||||||||
| FaxNumber: | 8598177851 | ||||||||
| Practice Location | |||||||||
| Address1: | 7626 UNIVERSITY DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450692509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137933933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | REIS | ||||||||
| AuthorizedOfficialFirstName: | JOANN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8598177070 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORTHOCINCY | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.