Provider Demographics
NPI:1215773932
Name:PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:013-996-8743
Mailing Address - Street 1:14201 PARK CENTER DR STE 410
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5251
Mailing Address - Country:US
Mailing Address - Phone:301-298-5334
Mailing Address - Fax:
Practice Address - Street 1:14999 HEALTH CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1075
Practice Address - Country:US
Practice Address - Phone:301-498-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric