Healthcare Provider Details

I. General information

NPI: 1801368097
Provider Name (Legal Business Name): KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FAIRLANE RD
READING PA
19606-9567
US

IV. Provider business mailing address

11 FAIRLANE RD
READING PA
19606-9567
US

V. Phone/Fax

Practice location:
  • Phone: 610-779-2663
  • Fax: 610-779-3367
Mailing address:
  • Phone: 610-779-2663
  • Fax: 610-779-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDY FEEHRER
Title or Position: BILLING MANAGER
Credential:
Phone: 610-779-2663