Provider Demographics
NPI:1588685242
Name:ORTHOPEDIC HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:ORTHOPEDIC HEALTHCARE ASSOCIATES INC
Other - Org Name:MAJESTRO MOLINA EDE MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAJESTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-343-4691
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CHARLESTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-343-1399
Mailing Address - Fax:304-345-7824
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:STE 104
Practice Address - City:CHARLESTOWN
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-343-1399
Practice Address - Fax:304-345-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6400400Medicaid
WV6400400Medicaid