Provider Demographics
NPI:1497209761
Name:KEYSTONE ORTHOPAEDIC SPECIALISTS,LLC
Entity Type:Organization
Organization Name:KEYSTONE ORTHOPAEDIC SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
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:484-509-0480
Mailing Address - Street 1:2607 KEISER BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3338
Mailing Address - Country:US
Mailing Address - Phone:484-509-0840
Mailing Address - Fax:610-678-2100
Practice Address - Street 1:2607 KEISER BLVD # 200
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:484-509-0840
Practice Address - Fax:610-678-2100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054229L332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies