Provider Demographics
NPI:1497929293
Name:KEYSTONE ORTHOPAEDIC & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:KEYSTONE ORTHOPAEDIC & REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-988-0611
Mailing Address - Street 1:227 N BROAD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1503
Mailing Address - Country:US
Mailing Address - Phone:215-988-0611
Mailing Address - Fax:215-988-0722
Practice Address - Street 1:227 N BROAD ST
Practice Address - Street 2:STE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1503
Practice Address - Country:US
Practice Address - Phone:215-988-0611
Practice Address - Fax:215-988-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0404550001Medicare NSC