1588828313 NPI number — LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE

Table of content: (NPI 1588828313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588828313 NPI number — LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE
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:
1588828313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3120 WILMINGTON RD
Provider Second Line Business Mailing Address:
B
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16105-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-657-6852
Provider Business Mailing Address Fax Number:
724-657-8945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 WILMINGTON RD
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-1168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-657-6852
Provider Business Practice Location Address Fax Number:
724-657-8945
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCGANN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
724-658-5311

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT007700L , 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: LA995541 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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