Basic Information
| Provider Information | |||||||||
| NPI: | 1013468719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ORTHOPAEDIC AND SPORTS MEDICINE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066114552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032682882 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 POST RD E | ||||||||
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| City: | WESTPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068805607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032541354 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | TRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2032682882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.