Provider Demographics
NPI:1942499900
Name:ORTHOPAEDIC SPECIALISTS OF THE CAROLINAS, P.A.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF THE CAROLINAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-768-1270
Mailing Address - Street 1:170 KIMEL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6946
Mailing Address - Country:US
Mailing Address - Phone:336-768-1270
Mailing Address - Fax:336-765-6375
Practice Address - Street 1:170 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-768-1270
Practice Address - Fax:336-765-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75970332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890110QMedicaid
NC2321385Medicare PIN