1588051155 NPI number — PREMIER ORTHOPEDICS, P.A.

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 1588051155 NPI number — PREMIER ORTHOPEDICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER ORTHOPEDICS, P.A.
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:
1588051155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3570 SAINT JOHNS LN
Provider Second Line Business Mailing Address:
FREDERICK CROSSING
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21042-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-461-9500
Provider Business Mailing Address Fax Number:
410-461-8945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9135 PISCATAWAY RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-348-7390
Provider Business Practice Location Address Fax Number:
301-560-8303
Provider Enumeration Date:
04/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BUSCH
Authorized Official First Name:
MYRA
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
PRACTICE COORDINATOR
Authorized Official Telephone Number:
410-461-9500

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)





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