Provider Demographics
NPI:1518943364
Name:CAROLINA MUSCULOSKELETAL INSTITUTE PA
Entity Type:Organization
Organization Name:CAROLINA MUSCULOSKELETAL INSTITUTE PA
Other - Org Name:CAROLINA ORTHOPEDIC ASSOCIATES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-644-4264
Mailing Address - Street 1:410 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6810
Mailing Address - Country:US
Mailing Address - Phone:803-644-4264
Mailing Address - Fax:803-293-1523
Practice Address - Street 1:410 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6810
Practice Address - Country:US
Practice Address - Phone:803-644-4264
Practice Address - Fax:803-293-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RR0500X, 207X00000X, 2085B0100X
SC2084N0400X
SC59213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9908Medicaid
SCPA4030Medicaid
SCPA4030Medicaid
SC0351410001Medicare NSC