Basic Information
| Provider Information | |||||||||
| NPI: | 1699739805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC SURGEONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 WEST 26 STREET | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165081898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144542401 | ||||||||
| FaxNumber: | 8144595992 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 WEST 26 STREET | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165081898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144542401 | ||||||||
| FaxNumber: | 8144595992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | STEPHAN | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8144542401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 119770100 | 01 | PA | US DEPT OF LABOR | OTHER | 1453653 | 01 | PA | HIGHMARK PT | OTHER | 008032 | 01 | PA | HIGHMARK OFC | OTHER | CF2245 | 01 | RR MEDICARE | OTHER | 0007283130005 | 05 | PA | MEDICAID |