1073570701 NPI number — LN SOTOS ORTHOPAEDIC ASSOCIATES PC

Table of content: (NPI 1073570701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073570701 NPI number — LN SOTOS ORTHOPAEDIC ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LN SOTOS ORTHOPAEDIC ASSOCIATES PC
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:
6
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:
1073570701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 N PARK DR
Provider Second Line Business Mailing Address:
SUITE #2
Provider Business Mailing Address City Name:
KITTANNING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16201-7117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-548-4120
Provider Business Mailing Address Fax Number:
724-545-3421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 N PARK DR
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-7117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-548-4120
Provider Business Practice Location Address Fax Number:
724-545-3421
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOTOS
Authorized Official First Name:
LAZAROS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
724-548-4120

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD012272E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0679667 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S019573 . This is a "BSP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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