Provider Demographics
NPI:1417060443
Name:ORTHOPEDIC ASSOCIATES OF POTTSVILLE
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF POTTSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOUDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-622-5672
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-0510
Mailing Address - Country:US
Mailing Address - Phone:570-622-5672
Mailing Address - Fax:570-622-6099
Practice Address - Street 1:700 SCHUYLKILL MANOR RD
Practice Address - Street 2:SUITE 1
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3849
Practice Address - Country:US
Practice Address - Phone:570-622-5672
Practice Address - Fax:570-622-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACF3054OtherTRAVELERS MEDICARE
074506OtherHIGHMARK BS
PA074506Medicare ID - Type Unspecified