Provider Demographics
NPI:1669157376
Name:PORTSMOUTH ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:PORTSMOUTH ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:949-371-7443
Mailing Address - Street 1:170 COMMERCE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3272
Mailing Address - Country:US
Mailing Address - Phone:949-371-7443
Mailing Address - Fax:603-607-5001
Practice Address - Street 1:170 COMMERCE WAY STE 200
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3272
Practice Address - Country:US
Practice Address - Phone:949-371-7443
Practice Address - Fax:603-607-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty