Provider Demographics
NPI:1790873586
Name:CAROLINA ORTHOPEDICS AND SPORTS MEDICINE SPECIALISTS, PA
Entity Type:Organization
Organization Name:CAROLINA ORTHOPEDICS AND SPORTS MEDICINE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-878-9004
Mailing Address - Street 1:702 HARTNESS RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3425
Mailing Address - Country:US
Mailing Address - Phone:704-878-9004
Mailing Address - Fax:704-878-0047
Practice Address - Street 1:702 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3425
Practice Address - Country:US
Practice Address - Phone:704-878-9004
Practice Address - Fax:704-878-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962463372OtherPROVIDER NPI
NC0110BOtherBLUE CROSS BLUE SHIELD
NCDG6437OtherRAILROAD MEDICARE
NC890110BMedicaid
NC1104884964OtherPROVIDER NPI
NC0110BOtherBLUE CROSS BLUE SHIELD