Provider Demographics
NPI:1629076609
Name:PHOENIXVILLE ORTHOPEDIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:PHOENIXVILLE ORTHOPEDIC ASSOCIATES, PC
Other - Org Name:RPS ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-935-1120
Mailing Address - Street 1:400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3810
Mailing Address - Country:US
Mailing Address - Phone:610-935-5507
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3810
Practice Address - Country:US
Practice Address - Phone:610-935-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANONE207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0784018Medicaid
PA0784018Medicaid
PA407952Medicare ID - Type Unspecified