Provider Demographics
NPI:1184828808
Name:CHARLESTON BONE & JOINT PA
Entity Type:Organization
Organization Name:CHARLESTON BONE & JOINT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THESING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-853-3474
Mailing Address - Street 1:255 E BAY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2632
Mailing Address - Country:US
Mailing Address - Phone:843-853-3474
Mailing Address - Fax:843-853-3500
Practice Address - Street 1:767 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3027
Practice Address - Country:US
Practice Address - Phone:843-853-3474
Practice Address - Fax:843-853-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0535Medicaid
SC4116Medicare ID - Type Unspecified
4116Medicare UPIN