Provider Demographics
NPI:1821315094
Name:KEYSTONE ORTHOPAEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:KEYSTONE ORTHOPAEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-779-2663
Mailing Address - Street 1:11 FAIRLANE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9567
Mailing Address - Country:US
Mailing Address - Phone:610-779-2663
Mailing Address - Fax:610-779-3367
Practice Address - Street 1:11 FAIRLANE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9567
Practice Address - Country:US
Practice Address - Phone:610-779-2663
Practice Address - Fax:610-779-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6396440004Medicare NSC