Provider Demographics
NPI:1205024007
Name:CENTRAL CAROLINA ORTHOPAEDIC
Entity Type:Organization
Organization Name:CENTRAL CAROLINA ORTHOPAEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-774-1355
Mailing Address - Street 1:PO BOX 3247
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-3247
Mailing Address - Country:US
Mailing Address - Phone:919-774-1355
Mailing Address - Fax:919-775-1644
Practice Address - Street 1:1139 CARTHAGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4111
Practice Address - Country:US
Practice Address - Phone:919-774-1355
Practice Address - Fax:919-775-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty