MEDICARE: PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207RS0010X	Sports Medicine (Internal Medicine) Physician
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1427788553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	PO BOX 5228
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-0405
Country	:	US
Telephone Number	:	610-359-5671
Fax Number	:	610-482-9409

Provider Business Practice Location Address
First Line	:	455 WOODVIEW RD STE 205
Second Line	:
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9315
Country	:	US
Telephone Number	:	610-692-6280
Fax Number	:	610-482-9409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY MALUMED
Credential	:	MD
Telephone Number	:	610-521-8970

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	08/04/2022

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