Provider Demographics
NPI:1427028794
Name:PENNSYLVANIA MUSCLE BONE AND JOINT LLC
Entity Type:Organization
Organization Name:PENNSYLVANIA MUSCLE BONE AND JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-628-6858
Mailing Address - Street 1:111 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3004
Mailing Address - Country:US
Mailing Address - Phone:570-628-6858
Mailing Address - Fax:570-628-4054
Practice Address - Street 1:111 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3004
Practice Address - Country:US
Practice Address - Phone:570-628-6858
Practice Address - Fax:570-628-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1236500001Medicare NSC
PA116539Medicare PIN