Basic Information
| Provider Information | |||||||||
| NPI: | 1275852782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 SPROUL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190083511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103591580 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2004 SPROUL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190083511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103591580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2010 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | STOTT | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6103595664 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.