1033419569 NPI number — CARY ORTHOPAEDIC & SPORTS MEDICINE SPECIALISTS, PA

Table of content: (NPI 1033419569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033419569 NPI number — CARY ORTHOPAEDIC & SPORTS MEDICINE SPECIALISTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARY ORTHOPAEDIC & SPORTS MEDICINE SPECIALISTS, PA
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:
1033419569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 SE CARY PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518-7413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-467-4992
Provider Business Mailing Address Fax Number:
919-235-0134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 SE CARY PKWY
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27518-7420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-297-0000
Provider Business Practice Location Address Fax Number:
919-232-5328
Provider Enumeration Date:
11/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCARDLE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
919-467-4992

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  PV43190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PV43190 . This is a "ACR AMERICAN COLLEGE OF RADIOLOGY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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