Provider Demographics
NPI:1144213398
Name:ORTHOPAEDIC SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-226-1199
Mailing Address - Street 1:1624 PACIFIC AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2101
Mailing Address - Country:US
Mailing Address - Phone:724-226-1199
Mailing Address - Fax:724-226-1479
Practice Address - Street 1:1624 PACIFIC AVE
Practice Address - Street 2:STE. A
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2101
Practice Address - Country:US
Practice Address - Phone:724-226-1199
Practice Address - Fax:724-226-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2009-02-19
Deactivation Date:2009-01-20
Deactivation Code:
Reactivation Date:2009-02-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0429000001Medicare NSC