Provider Demographics
NPI: | 1376592964 |
---|---|
Name: | EMERGEORTHO PA |
Entity Type: | Organization |
Organization Name: | EMERGEORTHO PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF VBO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DARCI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARVEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 704-942-4391 |
Mailing Address - Street 1: | 120 WILLIAM PENN PLAZA |
Mailing Address - Street 2: | |
Mailing Address - City: | DURHAM |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27704-2150 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-220-5255 |
Mailing Address - Fax: | 919-313-1276 |
Practice Address - Street 1: | 120 WILLIAM PENN PLAZA |
Practice Address - Street 2: | |
Practice Address - City: | DURHAM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27704-2150 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-220-5255 |
Practice Address - Fax: | 919-313-1276 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-09 |
Last Update Date: | 2022-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 39442 | 103T00000X, 207L00000X, 207RR0500X, 207X00000X, 207XX0005X, 208100000X, 2084N0400X, 2085R0204X, 208600000X, 2086S0105X, 213E00000X, 225100000X, 225X00000X, 363A00000X, 363LA2200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0105X | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 0401990001 | Other | MEDICARE PTAN |
NC | 02837 | Other | BCBS |
NC | 0098095 | Other | AETNA, HMO |
NC | 722786 | Other | UPMC |
NC | CC8880 | Other | RAILROAD MEDICARE |
NC | 0004446928 | Other | AETNA, PPO |
NC | 371772200 | Other | US DEPT. OF LABOR |
NC | 8902837 | Medicaid | |
NC | 8902837 | Medicaid | |
NC | 2329277 | Medicare PIN | |
NC | 0004446928 | Other | AETNA, PPO |
NC | 02837 | Other | BCBS |
NC | 2819810 | Medicare PIN |