Provider Demographics
NPI:1376058735
Name:SPORTS MEDICINE & JOINT REPLACEMENT SPECIALISTS CORPORATION
Entity Type:Organization
Organization Name:SPORTS MEDICINE & JOINT REPLACEMENT SPECIALISTS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:FLINN
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:412-207-9780
Mailing Address - Street 1:345 MOUNT LEBANON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1504
Mailing Address - Country:US
Mailing Address - Phone:412-207-9780
Mailing Address - Fax:412-207-9782
Practice Address - Street 1:542 RUGH ST STE 2000
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5623
Practice Address - Country:US
Practice Address - Phone:412-207-9780
Practice Address - Fax:412-207-9782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPORTS MEDICINE & JOINT REPLACEMENT SPECIALISTS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021997440001Medicaid