Provider Demographics
NPI:1376720151
Name:ORTHOPAEDIC SPECIALISTS OF CHARLESTON
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-958-2500
Mailing Address - Street 1:PO BOX 601813
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1813
Mailing Address - Country:US
Mailing Address - Phone:843-958-2500
Mailing Address - Fax:843-856-2599
Practice Address - Street 1:2891 TRICOM ST STE A
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7110
Practice Address - Country:US
Practice Address - Phone:843-958-2500
Practice Address - Fax:843-569-5931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC SPECIALISTS OF CHARLESTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0431230003332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5337Medicare PIN