Provider Demographics
NPI:1174794978
Name:STOW KENT ORTHOPAEDICS, INC.
Entity type:Organization
Organization Name:STOW KENT ORTHOPAEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-673-5519
Mailing Address - Street 1:174 CURRIE HALL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4387
Mailing Address - Country:US
Mailing Address - Phone:330-673-5519
Mailing Address - Fax:330-673-7950
Practice Address - Street 1:174 CURRIE HALL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4387
Practice Address - Country:US
Practice Address - Phone:330-673-5519
Practice Address - Fax:330-673-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042582207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0548401Medicaid
OHA50377Medicare UPIN
OHPRO469643Medicare PIN
OH0548401Medicaid