Basic Information
| Provider Information | |||||||||
| NPI: | 1417687856 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5228 | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193800405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103595671 | ||||||||
| FaxNumber: | 6104829409 | ||||||||
| Practice Location | |||||||||
| Address1: | 491 JOHN YOUNG WAY STE 210 | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105247251 | ||||||||
| FaxNumber: | 6104829409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | MALUMED | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6105218970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.