Basic Information
| Provider Information | |||||||||
| NPI: | 1730102781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPER BUCKS ORTHOPAEDIC ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 LAWN AVE | ||||||||
| Address2: | BUILDING 3 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152573700 | ||||||||
| FaxNumber: | 2152570360 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 LAWN AVE | ||||||||
| Address2: | BUILDING 3 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152573700 | ||||||||
| FaxNumber: | 2152570360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUMGARDNER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2152573700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0006833380002 | 05 | PA | MEDICAID | 0021804000 | 01 | PA | IBC | OTHER |