Provider Demographics
NPI:1558313478
Name:RALEIGH HAND TO SHOULDER CENTER PA
Entity Type:Organization
Organization Name:RALEIGH HAND TO SHOULDER CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:919-872-3171
Mailing Address - Street 1:3701 WAKE FOREST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6832
Mailing Address - Country:US
Mailing Address - Phone:919-872-3171
Mailing Address - Fax:919-872-6739
Practice Address - Street 1:3701 WAKE FOREST RD STE 3100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6832
Practice Address - Country:US
Practice Address - Phone:919-872-3171
Practice Address - Fax:919-872-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902752Medicaid
NC0414620001Medicare NSC
NC2312044Medicare PIN
NC7902752Medicaid