Provider Demographics
NPI:1881631612
Name:NORTHWEST ORTHOPAEDIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHWEST ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-462-4877
Mailing Address - Street 1:550 PINETOWN RD
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2605
Mailing Address - Country:US
Mailing Address - Phone:267-462-4877
Mailing Address - Fax:267-472-4878
Practice Address - Street 1:550 PINETOWN RD
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2605
Practice Address - Country:US
Practice Address - Phone:267-462-4877
Practice Address - Fax:267-472-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14845OtherHEALTH PARTNERS
PA0017492740003Medicaid
PA4606368OtherAETNA PPO
PA000374924OtherHIGHMARK BLUE SHIELD
PA0189129000OtherHMO BLUES
PA2059961OtherAETNA US HEALTHCARE
PA46833OtherKEYSTONE MERCY
PA4606368OtherAETNA PPO