1881631612 NPI number — NORTHWEST ORTHOPAEDIC SPECIALISTS LLC

Table of content: (NPI 1881631612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881631612 NPI number — NORTHWEST ORTHOPAEDIC SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ORTHOPAEDIC SPECIALISTS LLC
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:
1881631612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 PINETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-462-4877
Provider Business Mailing Address Fax Number:
267-472-4878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 PINETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19034-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-462-4877
Provider Business Practice Location Address Fax Number:
267-472-4878
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
267-462-4877

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 14845 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017492740003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4606368 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000374924 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0189129000 . This is a "HMO BLUES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2059961 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 46833 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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