1003954520 NPI number — ORTHOPAEDIC SPECIALTY CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003954520 NPI number — ORTHOPAEDIC SPECIALTY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC SPECIALTY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOMARYLAND
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003954520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 PARK CENTER COURT
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-377-8900
Provider Business Mailing Address Fax Number:
410-377-0576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 QUARRY LAKE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21209-3746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-377-8900
Provider Business Practice Location Address Fax Number:
410-377-0576
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-377-8900

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 911351700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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