Basic Information
| Provider Information | |||||||||
| NPI: | 1780033845 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTGOMERY COUNTY HAND CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE UPPER EXTREMITY INSTITUTE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 DEKALB PIKE STE 204 | ||||||||
| Address2: | |||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194223367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102771990 | ||||||||
| FaxNumber: | 6102772007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 DEKALB PIKE STE 204 | ||||||||
| Address2: | |||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194223367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102771990 | ||||||||
| FaxNumber: | 6102772007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2016 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | DUGAB | ||||||||
| AuthorizedOfficialFirstName: | CANDICE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | HEALTH ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6102771990 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | PA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207XS0106X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.