Provider Demographics
NPI:1346541034
Name:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:THE READING NECK AND SPINE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-372-1140
Mailing Address - Street 1:PO BOX 9202
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9202
Mailing Address - Country:US
Mailing Address - Phone:610-372-1140
Mailing Address - Fax:610-372-7684
Practice Address - Street 1:1270 BROADCASTING RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3203
Practice Address - Country:US
Practice Address - Phone:610-372-1140
Practice Address - Fax:610-372-7684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-11
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054229L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255666012OtherGROUP NPI NUMBER
173951OtherGROUP PTAN
PA6396440006Medicare NSC