Provider Demographics
NPI:1053303347
Name:ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PC
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHARPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-644-7755
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-0968
Mailing Address - Country:US
Mailing Address - Phone:610-644-7755
Mailing Address - Fax:610-644-8290
Practice Address - Street 1:254 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1723
Practice Address - Country:US
Practice Address - Phone:610-644-7755
Practice Address - Fax:610-644-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACI3754OtherRAILROAD MEDICARE
PA30376OtherUS HEALTHCARE
DEG01550OtherMEDICARE OF DELAWARE
DE465833OtherUS HEALTHCARE
000386934OtherBLUE CROSS/BLUE SHIELD
DE465833OtherUS HEALTHCARE