Healthcare Provider Details

I. General information

NPI: 1740699966
Provider Name (Legal Business Name): PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 INDUSTRIAL BLVD STE 165
PAOLI PA
19301-1605
US

IV. Provider business mailing address

PO BOX 34990
BELFAST ME
04915-0627
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6900
  • Fax: 833-941-3871
Mailing address:
  • Phone: 610-359-5640
  • Fax: 833-941-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY MALUMED
Title or Position: PRESIDENT
Credential:
Phone: 610-521-9996