Provider Demographics
NPI:1568454056
Name:CAROLINA ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:CAROLINA ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALCHER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:864-582-6396
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:STE 1600
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2244
Mailing Address - Country:US
Mailing Address - Phone:864-582-6396
Mailing Address - Fax:864-582-1608
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:STE 1600
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2244
Practice Address - Country:US
Practice Address - Phone:864-582-6396
Practice Address - Fax:864-582-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10436207X00000X
SC17900207X00000X
SC11210207XS0117X
SC13517207XS0117X
SC10774207XS0117X
SC16064207XX0004X
SC26630207XX0005X
SC8602084V0102X
SCA153363AS0400X
SCA843363AS0400X
SC1028363AS0400X
SC1157363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0604Medicaid
SC1223OtherMEDICARE PROVIDER NUMBER
SCCL0608OtherRAILROAD MEDICARE GROUP #
SC1223Medicare PIN
SCPA0604Medicaid