Healthcare Provider Details

I. General information

NPI: 1699138065
Provider Name (Legal Business Name): WESTERN PENNSYLVANIA ORTHOPEDICS AND SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 JAMESWAY RD
EBENSBURG PA
15931-4207
US

IV. Provider business mailing address

2 CELESTE DR
JOHNSTOWN PA
15905-2832
US

V. Phone/Fax

Practice location:
  • Phone: 814-255-6781
  • Fax: 814-255-5716
Mailing address:
  • Phone: 814-255-6781
  • Fax: 814-255-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6000007302
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000007302
License Number StatePA

VIII. Authorized Official

Name: DR. IAN KATZ
Title or Position: ORTHOPEDIC SURGEON / CORP SECRETARY
Credential: M.D.
Phone: 814-255-6781