Provider Demographics
NPI:1821066002
Name:CAROLINA ORTHOPAEDIC CENTER
Entity Type:Organization
Organization Name:CAROLINA ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-234-9900
Mailing Address - Street 1:209 PATEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3589
Mailing Address - Country:US
Mailing Address - Phone:864-234-9900
Mailing Address - Fax:864-234-9090
Practice Address - Street 1:209 PATEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3589
Practice Address - Country:US
Practice Address - Phone:864-234-9900
Practice Address - Fax:864-234-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1029Medicaid
SCDE1993Medicaid
SCDE1993Medicaid
SC=========OtherTAX ID
SCGP1029Medicaid