Organization
ORTHOPEDIC ASOC OF SW OHIO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL A LOCKARD (CREDENTIALING SPECIALIST)
(937) 415-9100
Entity
Organization
Contact information
Practice address
4160 LITTLE YORK RD, STE 10, DAYTON, OH 45414-5803
(937) 415-9100
(937) 415-9191
Mailing address
4160 LITTLE YORK RD, STE 10, DAYTON, OH 45414-5803
(937) 415-9100
(937) 415-9191
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2693821
—
OH
01
—
CF6697
RR MEDICARE
OH
Enumeration date
08/15/2005
Last updated
09/11/2008
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