Provider Demographics
NPI:1336178987
Name:MEDEAST POST-OP & SURGICAL, INC.
Entity type:Organization
Organization Name:MEDEAST POST-OP & SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-433-1073
Mailing Address - Street 1:580 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3923
Mailing Address - Country:US
Mailing Address - Phone:888-629-2030
Mailing Address - Fax:267-299-9001
Practice Address - Street 1:580 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3923
Practice Address - Country:US
Practice Address - Phone:888-629-2030
Practice Address - Fax:267-299-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000007808332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0199532Medicaid
PA0002051000OtherINDEPENDENCE BLUE CROSS
PA1022940370001Medicaid
PAA08010870OtherMEDICARE EDI SUBMITTER #
PA001604998OtherHIGHMARK BLUE SHIELD
PA330022900OtherU.S. DEPT. OF LABOR/ACS
PAA08010870OtherMEDICARE EDI SUBMITTER #
PA330022900OtherU.S. DEPT. OF LABOR/ACS
NJ0199532Medicaid