MEDICARE: PREMIER ORTHOPAEDIC & SPORTS MEDICINE ASSO., LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1174071823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ORTHOPAEDIC & SPORTS MEDICINE ASSO., LTD.

Provider Business Mailing Address
First Line	:	PO BOX 5228
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-0405
Country	:	US
Telephone Number	:	610-359-5640
Fax Number	:	610-359-1519

Provider Business Practice Location Address
First Line	:	2004 FOULK RD
Second Line	:	SUITE 3
City	:	WILMINGTON
State	:	DE
Zip	:	19810-3641
Country	:	US
Telephone Number	:	610-876-0347
Fax Number	:	610-876-4789

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY MALUMED
Credential	:	MD
Telephone Number	:	610-359-5660

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	02/10/2022

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