Provider Demographics
NPI:1215965561
Name:ORTHOPEDIC SPECIALISTS, LLC
Entity type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-548-9423
Mailing Address - Street 1:10 BRAMBLE BUSH DR
Mailing Address - Street 2:C/O ASAP MEDICAL SERVICES
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-548-9423
Mailing Address - Fax:508-548-5239
Practice Address - Street 1:5 BRAMBLE BUSH DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-548-9423
Practice Address - Fax:508-548-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80345207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000000029156OtherBMC HEALTHNET GROUP
MAWIM17214OtherBLUE SHIELD GROUP NUMBER
171098OtherHARVARD PILGRIM GROUP
CG4764OtherRR MEDICARE GROUP NO.
667830OtherTUFTS GROUP NUMBER
MA9785787Medicaid
667830OtherTUFTS GROUP NUMBER
=========OtherSTANDARD TAX ID NO
CG4764OtherRR MEDICARE GROUP NO.
MAWIM17214OtherBLUE SHIELD GROUP NUMBER
=========OtherSTANDARD TAX ID NO