Provider Demographics
NPI:1801085352
Name:NORTHWEST ORTHOPAEDIC ASSOC PA
Entity type:Organization
Organization Name:NORTHWEST ORTHOPAEDIC ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:336-667-5039
Mailing Address - Street 1:1914 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3563
Mailing Address - Country:US
Mailing Address - Phone:336-667-5039
Mailing Address - Fax:336-667-5719
Practice Address - Street 1:1914 W PARK DR
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3563
Practice Address - Country:US
Practice Address - Phone:336-667-5039
Practice Address - Fax:336-667-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40711332B00000X, 335E00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1372221NORTOtherUMWA
NC200004899OtherRR MEDICARE
NC5950009Medicaid
NC200004899OtherRR MEDICARE
NC5950009Medicaid
NCC82089Medicare UPIN