Provider Demographics
NPI:1912197237
Name:ALLEN ORTHOPEDICS P A
Entity Type:Organization
Organization Name:ALLEN ORTHOPEDICS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-3358
Mailing Address - Street 1:404 HATFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-1126
Mailing Address - Country:US
Mailing Address - Phone:910-738-3358
Mailing Address - Fax:910-738-9174
Practice Address - Street 1:404 HATFIELD CT
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-1126
Practice Address - Country:US
Practice Address - Phone:910-738-3358
Practice Address - Fax:910-738-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800444174400000X
NC98-00444332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1290230002Medicare NSC
NCG82028Medicare UPIN