Provider Demographics
NPI:1073063079
Name:BACK MOUNTAIN ORTHOPEDICS P.C.
Entity Type:Organization
Organization Name:BACK MOUNTAIN ORTHOPEDICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-675-6737
Mailing Address - Street 1:2800 MEMORIAL HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1569
Mailing Address - Country:US
Mailing Address - Phone:570-675-6737
Mailing Address - Fax:570-675-7882
Practice Address - Street 1:2800 MEMORIAL HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1569
Practice Address - Country:US
Practice Address - Phone:570-675-6737
Practice Address - Fax:570-675-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024634E207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty