Provider Demographics
NPI:1497960629
Name:RALEIGH ORTHOPAEDIC PHARMACY
Entity Type:Organization
Organization Name:RALEIGH ORTHOPAEDIC PHARMACY
Other - Org Name:RALEIGH ORTHOPAEDIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BIZUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-863-6801
Mailing Address - Street 1:3001 EDWARDS MILL RD # 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:919-781-5600
Mailing Address - Fax:919-863-6821
Practice Address - Street 1:3001 EDWARDS MILL RD # 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5243
Practice Address - Country:US
Practice Address - Phone:919-863-6853
Practice Address - Fax:919-781-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919227Medicaid
NC5919227Medicaid