Organization
LOCK HAVEN MEDICAL PROFESSIONALS PC
Active
Organization
LOCK HAVEN MEDICAL PROFESSIONALS PC
Active
Other names
Haven Orthopedic and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
GARY NEWSOME (SENIOR VICE PRESIDENT)
(570) 893-5330
Entity
Organization
Contact information
Practice address
24 CREE DR, LOCK HAVEN, PA 17745-2639
(570) 893-5330
Mailing address
330 FRANKLIN ROAD,, #135A-501, BRENTWOOD, TN 37027
(615) 309-3300
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013815860001
—
PA
Enumeration date
03/21/2006
Last updated
08/22/2020
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