Provider Demographics
NPI:1861461592
Name:CAROLINA ORTHOPAEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CAROLINA ORTHOPAEDIC SPECIALISTS, LLC
Other - Org Name:CAROLINA ORTHOPAEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:843-294-1941
Mailing Address - Street 1:PO BOX 4746
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8746
Mailing Address - Country:US
Mailing Address - Phone:843-294-1941
Mailing Address - Fax:843-294-1945
Practice Address - Street 1:3545 HIGHWAY 17
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-294-1941
Practice Address - Fax:843-294-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD21586207X00000X
SCMMD.19213MD208100000X
SC566213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3856Medicaid
SC7833Medicare PIN
SC5155570002Medicare NSC
SCGP3856Medicaid