Provider Demographics
NPI:1619937745
Name:ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:ORTHOPAEDICS PA
Other - Org Name:RIVER VALLEY MUSCULOSKELETAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOLYARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-709-6700
Mailing Address - Street 1:PO BOX 11230
Mailing Address - Street 2:3501 W. E. KNIGHT DRIVE
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1230
Mailing Address - Country:US
Mailing Address - Phone:479-709-6767
Mailing Address - Fax:479-709-6768
Practice Address - Street 1:3501 WE KNIGHT DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6248
Practice Address - Country:US
Practice Address - Phone:479-709-6700
Practice Address - Fax:479-709-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1326160001OtherCIGNA GOVERNMENT
OK100756920AMedicaid
AR140859002Medicaid
CH0845OtherRAILROAD MEDICARE
OK100756920AMedicaid
1326160001Medicare NSC
OK800522511Medicare PIN