Provider Demographics
NPI:1245244813
Name:ORTHOCAROLINA
Entity Type:Organization
Organization Name:ORTHOCAROLINA
Other - Org Name:UNIVERSITY 5001
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-339-1000
Mailing Address - Street 1:1915 RANDOLPH RD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1101
Mailing Address - Country:US
Mailing Address - Phone:704-339-1224
Mailing Address - Fax:704-339-1444
Practice Address - Street 1:101 W.T. HARRIS BLVD
Practice Address - Street 2:SUITE 5001
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-547-7319
Practice Address - Fax:704-339-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901619Medicaid
NC8901619Medicaid