Provider Demographics
NPI:1255503181
Name:PREMIER ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:PREMIER ORTHOPAEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-876-0347
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-0081
Mailing Address - Country:US
Mailing Address - Phone:610-876-0347
Mailing Address - Fax:610-872-4759
Practice Address - Street 1:ONE MEDICAL CENTER BLVD.
Practice Address - Street 2:POB II, SUITE 324
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19015
Practice Address - Country:US
Practice Address - Phone:610-876-0347
Practice Address - Fax:610-872-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty