Basic Information
| Provider Information | |||||||||
| NPI: | 1548289697 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPEDIC ONE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 TAYLOR STATION RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145457900 | ||||||||
| FaxNumber: | 6145457901 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 TAYLOR STATION RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145457900 | ||||||||
| FaxNumber: | 6145457901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | POLITI | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6145457900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2506050 | 05 | OH | MEDICAID | 2506023 | 05 | OH | MEDICAID | 2472926 | 05 | OH | MEDICAID | 2505999 | 05 | OH | MEDICAID | 2506041 | 05 | OH | MEDICAID | 2514292 | 05 | OH | MEDICAID |