Provider Demographics
NPI: | 1942367636 |
---|---|
Name: | CENTER FOR ORTHOPAEDIC SURGERY, LLC |
Entity Type: | Organization |
Organization Name: | CENTER FOR ORTHOPAEDIC SURGERY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | ELKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 803-329-7402 |
Mailing Address - Street 1: | 118 PROFESSIONAL PARK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCK HILL |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29732-1178 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-329-3134 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 134 PROFESSIONAL PARK DR |
Practice Address - Street 2: | |
Practice Address - City: | ROCK HILL |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29732-1178 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-329-7402 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-02 |
Last Update Date: | 2015-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 261QA1903X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |