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NPI Code Detail

MEDICARE: PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES LTD

MEDICARE: PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES 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
1207XS0106XOrthopaedic Hand Surgery Physician
2207XS0117XOrthopaedic Surgery of the Spine Physician
3207XX0004XOrthopaedic Foot and Ankle Surgery Physician
4207XX0005XSports Medicine (Orthopaedic Surgery) Physician
52081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician
6213ES0103XFoot & Ankle Surgery Podiatrist
7363A00000XPhysician Assistant
8207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1508425992
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES LTD
Provider Business Mailing Address
First Line : 915 OLD FERN HILL ROAD
Second Line : BLDG A STE 1
City : WEST CHESTER
State : PA
Zip : 19380-4269
Country : US
Telephone Number : 610-692-6280
Fax Number : 610-429-1943
Provider Business Practice Location Address
First Line : 455 WOODVIEW RD STE 205
Second Line :
City : WEST GROVE
State : PA
Zip : 19390-9315
Country : US
Telephone Number : 484-748-6148
Fax Number : 610-869-2320
Authorized Official
Title or Position : EXECUTIVE ASSISTANT
Name : HEATHER DEFAZIO
Credential :
Telephone Number : 610-692-6280
Provider Enumeration Date : 06/10/2019
Last Update Date : 06/10/2019

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Directions to “PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES LTD ” Practice Location

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