1528085313 NPI number — ORTHOCAROLINA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528085313 NPI number — ORTHOCAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOCAROLINA
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:
KINGS MOUNTAIN
Provider Other Organization Name Type Code:
5
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:
1528085313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 PARK RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-323-2256
Provider Business Mailing Address Fax Number:
704-323-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 W KING ST
Provider Second Line Business Practice Location Address:
SUITE 100-C
Provider Business Practice Location Address City Name:
KINGS MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-739-0277
Provider Business Practice Location Address Fax Number:
704-339-1444
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAYMON
Authorized Official First Name:
TOM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
704-339-1000

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 8901619 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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