Provider Demographics
NPI:1295823649
Name:PERRY & BARRON ORTHOPEDICS & SPORTS MEDICINE, PA
Entity Type:Organization
Organization Name:PERRY & BARRON ORTHOPEDICS & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MAYNARD
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-358-0670
Mailing Address - Street 1:2826 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1019
Mailing Address - Country:US
Mailing Address - Phone:704-358-0670
Mailing Address - Fax:704-358-0039
Practice Address - Street 1:2826 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1019
Practice Address - Country:US
Practice Address - Phone:704-358-0670
Practice Address - Fax:704-358-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4599380001Medicare NSC
NC2327857Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION N