Provider Demographics
NPI:1497877161
Name:WELLBRIDGE ORTHOPAEDICS, PA
Entity Type:Organization
Organization Name:WELLBRIDGE ORTHOPAEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-732-9966
Mailing Address - Street 1:PO BOX 2059
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-2059
Mailing Address - Country:US
Mailing Address - Phone:704-732-9966
Mailing Address - Fax:704-732-3788
Practice Address - Street 1:701 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3652
Practice Address - Country:US
Practice Address - Phone:704-732-9966
Practice Address - Fax:704-732-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601702207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790293JMedicaid
NC790293JMedicaid