Provider Demographics
NPI:1710434451
Name:CAROLINA ORTHOPAEDIC SPECIALISTS
Entity Type:Organization
Organization Name:CAROLINA ORTHOPAEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-294-1941
Mailing Address - Street 1:185 FRESH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4436
Mailing Address - Country:US
Mailing Address - Phone:843-294-1941
Mailing Address - Fax:843-294-1945
Practice Address - Street 1:185 FRESH DR
Practice Address - Street 2:SUITE B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4436
Practice Address - Country:US
Practice Address - Phone:843-294-1941
Practice Address - Fax:843-294-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3856Medicaid
SC7833Medicare PIN
SCGP3856Medicaid