Provider Demographics
NPI:1588828313
Name:LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:LAWRENCE COUNTY ORTHOPEDICS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-658-5311
Mailing Address - Street 1:3120 WILMINGTON RD
Mailing Address - Street 2:B
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1168
Mailing Address - Country:US
Mailing Address - Phone:724-657-6852
Mailing Address - Fax:724-657-8945
Practice Address - Street 1:3120 WILMINGTON RD
Practice Address - Street 2:B
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1168
Practice Address - Country:US
Practice Address - Phone:724-657-6852
Practice Address - Fax:724-657-8945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-10
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007700L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA995541OtherBLUE CROSS BLUE SHIELD
PALA995541OtherBLUE CROSS BLUE SHIELD