Basic Information
| Provider Information | |||||||||
| NPI: | 1487846739 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMILTON ORTHOPAEDIC CLINIC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 N LOCUST ST | ||||||||
| Address2: | SUITE B 1 | ||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450561192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135241100 | ||||||||
| FaxNumber: | 5135240085 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 N LOCUST ST | ||||||||
| Address2: | SUITE B 1 | ||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450561192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135241100 | ||||||||
| FaxNumber: | 5135240085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 01/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | CANGEMI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5135241100 | ||||||||
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| 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 | 207X00000X | 36511 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100001310 | 05 | IN | MEDICAID | 0336827 | 05 | OH | MEDICAID |