Provider Demographics
NPI:1528197258
Name:PREMIER ORTHOPEDICS, P.A.
Entity Type:Organization
Organization Name:PREMIER ORTHOPEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-461-9500
Mailing Address - Street 1:3570 SAINT JOHNS LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4020
Mailing Address - Country:US
Mailing Address - Phone:410-461-9500
Mailing Address - Fax:410-461-8945
Practice Address - Street 1:75 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE N
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4895
Practice Address - Country:US
Practice Address - Phone:301-663-0009
Practice Address - Fax:301-695-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty