Provider Demographics
NPI:1225221997
Name:ORTHOPEDIC CENTER PC
Entity Type:Organization
Organization Name:ORTHOPEDIC CENTER PC
Other - Org Name:SOUTHEASTERN ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-5372
Mailing Address - Street 1:7 MALLETT WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6064
Mailing Address - Country:US
Mailing Address - Phone:800-827-6536
Mailing Address - Fax:
Practice Address - Street 1:7 MALLETT WAY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6064
Practice Address - Country:US
Practice Address - Phone:800-827-6536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty