Provider Demographics
NPI:1316034960
Name:ELMIRA ORTHOPAEDIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:ELMIRA ORTHOPAEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-795-1666
Mailing Address - Street 1:100 JOHN ROEMMELT DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8302
Mailing Address - Country:US
Mailing Address - Phone:607-795-1666
Mailing Address - Fax:607-796-0839
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-795-1666
Practice Address - Fax:607-796-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00372005Medicaid
NY34839AMedicare ID - Type Unspecified