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General NPI Number Information
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NPI Number | 1578776662
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Entity Type | Organization
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Legal Business Name | BLACK MOUNTAIN ORTHOPAEDICS ASSC LLP
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 1681 W HORIZON RIDGE PKWY BLACK MOUNTAIN ORTHOPAEDICS
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City | HENDERSON
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State | NV
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Zip | 89012
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Country | US
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Telephone | 702-564-1234
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Fax | 702-564-3361
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Provider Business Mailing Address
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Address Line | 1681 W HORIZON RIDGE PKWY BLACK MOUNTAIN ORTHOPAEDICS
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City | HENDERSON
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State | NV
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Zip | 89012
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Country | US
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Telephone | 702-564-1234
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Fax | 702-564-3361
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MICHAEL S RAVITCH
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Credential |
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Telephone | 702-564-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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