Provider Demographics
NPI:1821032681
Name:WEST PENN ORTHOPAEDICS, INC
Entity Type:Organization
Organization Name:WEST PENN ORTHOPAEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-226-1070
Mailing Address - Street 1:18 SPORTSMAN DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8538
Mailing Address - Country:US
Mailing Address - Phone:814-226-1070
Mailing Address - Fax:814-226-1072
Practice Address - Street 1:18 SPORTSMAN DR
Practice Address - Street 2:SUITE 20
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8538
Practice Address - Country:US
Practice Address - Phone:814-226-1070
Practice Address - Fax:814-226-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005397L207X00000X
PAMD035051E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011448100011Medicaid
PA140360Medicare ID - Type Unspecified