Provider Demographics
NPI:1790724706
Name:SOUTHEASTERN ORTHOPAEDIC SPECIALISTS, PA
Entity Type:Organization
Organization Name:SOUTHEASTERN ORTHOPAEDIC SPECIALISTS, PA
Other - Org Name:GUILFORD ORTHOPAEDIC & SPORTS MEDICINE CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-275-3325
Mailing Address - Street 1:1915 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7033
Mailing Address - Country:US
Mailing Address - Phone:336-275-3325
Mailing Address - Fax:336-275-5346
Practice Address - Street 1:1915 LENDEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7033
Practice Address - Country:US
Practice Address - Phone:336-275-3325
Practice Address - Fax:336-275-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890180GMedicaid
2322742GMedicare ID - Type Unspecified
NC1190220008Medicare NSC