1891861050 NPI number — ORTHOPEDIC AFFILIATES, INC.

Table of content: (NPI 1891861050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891861050 NPI number — ORTHOPEDIC AFFILIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC AFFILIATES, INC.
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:
1891861050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 BAKER AVENUE EXT
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01742-2137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-369-5391
Provider Business Mailing Address Fax Number:
978-369-7661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 BAKER AVENUE EXT
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-369-5391
Provider Business Practice Location Address Fax Number:
978-369-7661
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRISCOLL
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-369-5391

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: 19200 . This is a "FALLON COMMUNITY HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600190 . This is a "USFHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA9820 . This is a "RAILROAD MEDICARE-PALMETT" identifier . This identifiers is of the category "OTHER".
  • Identifier: M14423 . This is a "BCBS-MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600190 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P0501878 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".




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