=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053303347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 02/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 254 W LANCASTER AVE
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-7755
-----------------------------------------------------
Fax | 610-644-8290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 968
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-0968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-7755
-----------------------------------------------------
Fax | 610-644-8290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | LEWIS S SHARPS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 610-644-7755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------