Provider Demographics
NPI:1528039591
Name:WEST BRANCH ORTHOPEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:WEST BRANCH ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-322-3640
Mailing Address - Street 1:699 RURAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3246
Mailing Address - Country:US
Mailing Address - Phone:570-322-3640
Mailing Address - Fax:570-322-3656
Practice Address - Street 1:699 RURAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3246
Practice Address - Country:US
Practice Address - Phone:570-322-3640
Practice Address - Fax:570-322-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012256040001Medicaid
PA612779Medicare PIN
PA=========Medicare UPIN
PA0012256040001Medicaid