1659640761 NPI number — GOLDSBORO ORTHOPEDICS, LLC

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 1659640761 NPI number — GOLDSBORO ORTHOPEDICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDSBORO ORTHOPEDICS, 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:
GOLDSBORO ORTHPAEDIC ASSOCIATES, P.A,
Provider Other Organization Name Type Code:
4
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:
1659640761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1717
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27533-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-587-4081
Provider Business Mailing Address Fax Number:
919-587-0775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2808 MCLAMB PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27534-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-587-4081
Provider Business Practice Location Address Fax Number:
919-587-0775
Provider Enumeration Date:
12/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
CLYDE
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-587-4081

Provider Taxonomy Codes

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

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





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