Provider Demographics
NPI:1740225101
Name:SANDHILLS ORTHOPAEDIC AND SPINE CLINIC, PA
Entity Type:Organization
Organization Name:SANDHILLS ORTHOPAEDIC AND SPINE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR FINANCE/BUSINESS
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-692-3144
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28388-0660
Mailing Address - Country:US
Mailing Address - Phone:910-692-3144
Mailing Address - Fax:910-692-2261
Practice Address - Street 1:120 BRAEMAR COURT
Practice Address - Street 2:TURNBERRY WOOD
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28388
Practice Address - Country:US
Practice Address - Phone:910-692-3144
Practice Address - Fax:910-692-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29028207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC209904DMedicare ID - Type Unspecified