Provider Demographics
NPI:1750673133
Name:UNIVERSITY ORTHOPEDICS CENTER
Entity Type:Organization
Organization Name:UNIVERSITY ORTHOPEDICS CENTER
Other - Org Name:UOC PHARM-ALTOONA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-231-2101
Mailing Address - Street 1:101 REGENT CT
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7965
Mailing Address - Country:US
Mailing Address - Phone:814-231-2101
Mailing Address - Fax:814-231-8569
Practice Address - Street 1:3000 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4472
Practice Address - Country:US
Practice Address - Phone:800-505-2101
Practice Address - Fax:814-231-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA663347Medicare PIN