Provider Demographics
NPI:1881655801
Name:HARTSVILLE ORTHOPAEDICS & SPORTS MEDICINE, PA
Entity Type:Organization
Organization Name:HARTSVILLE ORTHOPAEDICS & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-383-3742
Mailing Address - Street 1:700 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4765
Mailing Address - Country:US
Mailing Address - Phone:843-383-3742
Mailing Address - Fax:843-383-3745
Practice Address - Street 1:700 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4765
Practice Address - Country:US
Practice Address - Phone:843-383-3742
Practice Address - Fax:843-383-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16595261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0807Medicaid
SCGP0807Medicaid