Provider Demographics
NPI:1376743070
Name:MCDOWELL ORTHOPAEDICS & SPORTS MEDICINE, P.A.
Entity Type:Organization
Organization Name:MCDOWELL ORTHOPAEDICS & SPORTS MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-652-1673
Mailing Address - Street 1:60 S MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-652-1262
Practice Address - Street 1:60 S MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4972
Practice Address - Country:US
Practice Address - Phone:828-652-1673
Practice Address - Fax:828-652-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891357EMedicaid
NC36931OtherBLUE CROSS OF NC PROVIDER
NCC637300Medicare UPIN
NC2337519Medicare PIN
NC891357EMedicaid