Provider Demographics
NPI:1881664027
Name:CHAPEL HILL ORTHOPEDIC SURGERY AND SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:CHAPEL HILL ORTHOPEDIC SURGERY AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-968-6008
Mailing Address - Street 1:101 CONNER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7038
Mailing Address - Country:US
Mailing Address - Phone:919-968-6008
Mailing Address - Fax:919-967-3860
Practice Address - Street 1:101 CONNER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7038
Practice Address - Country:US
Practice Address - Phone:919-968-6008
Practice Address - Fax:919-967-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25332207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946761Medicaid
NC8946761Medicaid
NC4518920001Medicare NSC