1447423843 NPI number — SPORTS MEDICINE & JOINT REPLACEMENT SPECIALISTS CORPORATION

Table of content: (NPI 1447423843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447423843 NPI number — SPORTS MEDICINE & JOINT REPLACEMENT SPECIALISTS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS MEDICINE & JOINT REPLACEMENT SPECIALISTS CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1447423843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-207-9780
Provider Business Mailing Address Fax Number:
412-207-9782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 MOUNT LEBANON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15234-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-207-9780
Provider Business Practice Location Address Fax Number:
412-207-9782
Provider Enumeration Date:
04/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HABIB
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
412-207-9780

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: 10109443001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".