Provider Demographics
NPI:1932186095
Name:ORTHOPEDIC PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ORTHOPEDIC PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER BILLING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MEDORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATOSKA
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE, CPC
Authorized Official - Phone:603-527-3866
Mailing Address - Street 1:14 MAPLE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6580
Mailing Address - Country:US
Mailing Address - Phone:603-528-9011
Mailing Address - Fax:603-524-5743
Practice Address - Street 1:14 MAPLE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6580
Practice Address - Country:US
Practice Address - Phone:603-528-9011
Practice Address - Fax:603-524-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8510207X00000X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81203738Medicaid
NHCB4367OtherRAILROAD MEDICARE
NH81203738Medicaid
NH81203738Medicaid