Provider Demographics
NPI:1588675474
Name:UNIVERSAL ORTHOPEDIC CO.
Entity Type:Organization
Organization Name:UNIVERSAL ORTHOPEDIC CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PAVELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:562-698-9965
Mailing Address - Street 1:12830 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4416
Mailing Address - Country:US
Mailing Address - Phone:562-698-9965
Mailing Address - Fax:562-404-1678
Practice Address - Street 1:12830 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4416
Practice Address - Country:US
Practice Address - Phone:562-698-9965
Practice Address - Fax:562-404-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXA000030Medicaid
CAGXA000030Medicaid