Basic Information
| Provider Information | |||||||||
| NPI: | 1235184193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERVILLE ORTHOPAEDICS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 568 S CLEVELAND AVE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148999966 | ||||||||
| FaxNumber: | 6148992744 | ||||||||
| Practice Location | |||||||||
| Address1: | 568 S CLEVELAND AVE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148999966 | ||||||||
| FaxNumber: | 6148992744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOLZAEPFEL | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6148999966 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 027476 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0536352 | 05 | OH | MEDICAID | 0108681 | 05 | OH | MEDICAID |