Provider Demographics
NPI:1245668698
Name:PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES LTD
Entity type:Organization
Organization Name:PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-644-6040
Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1743
Mailing Address - Country:US
Mailing Address - Phone:610-644-6040
Mailing Address - Fax:610-644-7202
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-644-6040
Practice Address - Fax:610-644-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044086E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034967Medicare PIN