Basic Information
| Provider Information | |||||||||
| NPI: | 1770906216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR ORTHOPEDICS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 TRANSPORTATION DR. | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403292800 | ||||||||
| FaxNumber: | 4403292810 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 KOLBE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403292800 | ||||||||
| FaxNumber: | 4403292810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2014 | ||||||||
| LastUpdateDate: | 02/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | SIMONE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4403297500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0203121 | 05 | OH | MEDICAID |