Provider Demographics
NPI:1164972147
Name:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:THE BONE & JOINT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LONGENECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-628-2663
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 365
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:484-628-2663
Mailing Address - Fax:484-628-2621
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 365
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:484-628-2663
Practice Address - Fax:484-628-2621
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA173951Medicare PIN