Provider Demographics
NPI:1063013399
Name:ORTHOPEDIC AND WELLNESS CENTER OF PHILADELPHIA PC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND WELLNESS CENTER OF PHILADELPHIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-396-7909
Mailing Address - Street 1:205 N BROAD ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1554
Mailing Address - Country:US
Mailing Address - Phone:215-496-9300
Mailing Address - Fax:215-496-9301
Practice Address - Street 1:205 N BROAD ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1554
Practice Address - Country:US
Practice Address - Phone:215-496-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty