Provider Demographics
NPI:1619030079
Name:CAROLINA BONE & JOINT PA
Entity Type:Organization
Organization Name:CAROLINA BONE & JOINT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLYN
Authorized Official - Last Name:BABICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-289-4595
Mailing Address - Street 1:PO BOX 5002
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-5002
Mailing Address - Country:US
Mailing Address - Phone:704-289-4595
Mailing Address - Fax:704-220-1005
Practice Address - Street 1:10460 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8403
Practice Address - Country:US
Practice Address - Phone:704-541-3055
Practice Address - Fax:704-602-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RR0500X, 207X00000X, 208VP0000X, 225100000X
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE02849Medicaid
NC8902849Medicaid
SCE02849Medicaid
0266370005Medicare NSC
NC8902849Medicaid