Provider Demographics
NPI:1184785875
Name:ORTHOPEDIC HEALTHCARE ASSOCIATES, INC.
Entity type:Organization
Organization Name:ORTHOPEDIC HEALTHCARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAJESTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-343-1399
Mailing Address - Street 1:415 MORRIS ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1840
Mailing Address - Country:US
Mailing Address - Phone:304-343-1399
Mailing Address - Fax:304-345-7824
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-343-1399
Practice Address - Fax:304-345-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTMP-01715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5162191OtherUNITED HEALTHCARE
WV001930217OtherBCBS MOUNTAIN STATE
WV1184785875OtherNPI
WV563182OtherCARELINK HEALTH PLANS
WV4611047OtherAETNA
WV4611047OtherAETNA
WV1184785875OtherNPI
WV5162191OtherUNITED HEALTHCARE
WV640816507OtherTIN