Provider Demographics
NPI:1578776662
Name:BLACK MOUNTAIN ORTHOPAEDICS ASSC LLP
Entity Type:Organization
Organization Name:BLACK MOUNTAIN ORTHOPAEDICS ASSC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-564-1234
Mailing Address - Street 1:1681 W HORIZON RIDGE PKWY
Mailing Address - Street 2:BLACK MOUNTAIN ORTHOPAEDICS
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012
Mailing Address - Country:US
Mailing Address - Phone:702-564-1234
Mailing Address - Fax:702-564-3361
Practice Address - Street 1:1681 W HORIZON RIDGE PKWY
Practice Address - Street 2:BLACK MOUNTAIN ORTHOPAEDICS
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012
Practice Address - Country:US
Practice Address - Phone:702-564-1234
Practice Address - Fax:702-564-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG68470Medicare UPIN
NVC96485Medicare UPIN
NV39546Medicare ID - Type UnspecifiedMICHAEL S. RAVITCH
NV40600Medicare ID - Type UnspecifiedPAUL A. MORGAN
NV39548Medicare ID - Type UnspecifiedROGER A. FONTES
NVR09717Medicare UPIN