Provider Demographics
NPI:1013025212
Name:PIEDMONT JOINT REPLACEMENT, BACK & SPORTS MEDICINE CENTER, PLLC
Entity Type:Organization
Organization Name:PIEDMONT JOINT REPLACEMENT, BACK & SPORTS MEDICINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOMARITIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-623-2623
Mailing Address - Street 1:110 S PARK TER
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5351
Mailing Address - Country:US
Mailing Address - Phone:336-623-2623
Mailing Address - Fax:336-623-7909
Practice Address - Street 1:110 S PARK TER
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5351
Practice Address - Country:US
Practice Address - Phone:336-623-2623
Practice Address - Fax:336-623-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0128VOtherBCBS OF NC
NC790128VMedicaid
NCB86153Medicare UPIN
NC0696730001Medicare NSC
NC2318396Medicare ID - Type Unspecified