=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821315094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYSTONE ORTHOPAEDIC SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2010
-----------------------------------------------------
Last Update Date | 04/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 FAIRLANE RD
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19606-9567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-779-2663
-----------------------------------------------------
Fax | 610-779-3367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 FAIRLANE RD
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19606-9567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-779-2663
-----------------------------------------------------
Fax | 610-779-3367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD MEMBER
-----------------------------------------------------
Name | DR. JOHN A MARTIN JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-779-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------