1053645705 NPI number — CAROLINA EAST ORTHOPEDIC SPECIALISTS LLC

Table of content: (NPI 1053645705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053645705 NPI number — CAROLINA EAST ORTHOPEDIC SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA EAST ORTHOPEDIC SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053645705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-2299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-470-3700
Provider Business Mailing Address Fax Number:
330-497-7940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 NEUSE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28560-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-633-8005
Provider Business Practice Location Address Fax Number:
252-633-8004
Provider Enumeration Date:
09/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOYCE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
866-885-5522

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)