Basic Information
| Provider Information | |||||||||
| NPI: | 1801979976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC & SPORTS MEDICINE CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 MORRIS RD | ||||||||
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| City: | CIRCLEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431131362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404776511 | ||||||||
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| Address1: | 130 MORRIS RD | ||||||||
| Address2: | |||||||||
| City: | CIRCLEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431131362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404776511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 10/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | TOSCANO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7404776511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.