Provider Demographics
NPI:1790849396
Name:NORTH CAROLINA SPORTS MEDICINE INSTITUTE PLLC
Entity Type:Organization
Organization Name:NORTH CAROLINA SPORTS MEDICINE INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALLSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-9411
Mailing Address - Street 1:185 KIMEL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 KIMEL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6973
Practice Address - Country:US
Practice Address - Phone:336-760-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty