Provider Demographics
NPI:1912035593
Name:NORTHERN CAROLINA ORTHOPAEDICS, PLLC
Entity Type:Organization
Organization Name:NORTHERN CAROLINA ORTHOPAEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-5631
Mailing Address - Street 1:171 NC HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6460
Mailing Address - Country:US
Mailing Address - Phone:252-537-5631
Mailing Address - Fax:252-537-7198
Practice Address - Street 1:171 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6460
Practice Address - Country:US
Practice Address - Phone:252-537-5631
Practice Address - Fax:252-537-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5850336Medicaid
NC020GAOtherBCBSNC
NCDO3170OtherRAILROAD MEDICARE
NC020GAOtherBCBSNC
NC5850336Medicaid