Provider Demographics
NPI:1194033829
Name:CAROLINA ORTHOPAEDIC SURGERY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CAROLINA ORTHOPAEDIC SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-329-7402
Mailing Address - Street 1:134 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1178
Mailing Address - Country:US
Mailing Address - Phone:803-329-3130
Mailing Address - Fax:803-329-2611
Practice Address - Street 1:1690 WEST HWY 160
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715
Practice Address - Country:US
Practice Address - Phone:803-548-2425
Practice Address - Fax:803-329-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC0637Medicaid
SC2550Medicare UPIN