Provider Demographics
NPI:1821479163
Name:CAROLINA ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:CAROLINA ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-292-3441
Mailing Address - Street 1:PO BOX 7396
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-7396
Mailing Address - Country:US
Mailing Address - Phone:803-292-3441
Mailing Address - Fax:
Practice Address - Street 1:191 CENTRE SOUTH BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6313
Practice Address - Country:US
Practice Address - Phone:803-292-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10145207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty