Provider Demographics
NPI:1760441711
Name:TRI-COUNTY ORTHOPEDIC & SPORTS MEDICINE, PA
Entity Type:Organization
Organization Name:TRI-COUNTY ORTHOPEDIC & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:336-526-4500
Mailing Address - Street 1:400 JOHNSON RIDGE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2447
Mailing Address - Country:US
Mailing Address - Phone:336-526-4500
Mailing Address - Fax:336-526-2324
Practice Address - Street 1:400 JOHNSON RIDGE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2447
Practice Address - Country:US
Practice Address - Phone:336-526-4500
Practice Address - Fax:336-526-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890281HMedicaid
NC0281HOtherGROUP BCBS NUMBER
NC0281HOtherGROUP BCBS NUMBER
NC2316297Medicare PIN