Provider Demographics
NPI:1538202932
Name:ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, INC.
Entity type:Organization
Organization Name:ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-685-8059
Mailing Address - Street 1:231 SUTTON ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1620
Mailing Address - Country:US
Mailing Address - Phone:978-685-8059
Mailing Address - Fax:978-685-6421
Practice Address - Street 1:231 SUTTON ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-685-8059
Practice Address - Fax:978-685-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005861OtherNEIGHBORHOOD HEALTH PLAN
MA0029570OtherAETNA
MA702745OtherTUFTS HEALTH PLAN
MAY65560OtherBLUE CROSS
MA622672OtherHARVARD PILGRIM
MA9721401Medicaid
MA97258201OtherNETWORK HEALTH
MA9721401Medicaid