Provider Demographics
NPI:1962501528
Name:MID-SOUTH ORTHOPAEDIC,PA
Entity Type:Organization
Organization Name:MID-SOUTH ORTHOPAEDIC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MG
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-295-4500
Mailing Address - Street 1:40 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9700
Mailing Address - Country:US
Mailing Address - Phone:910-295-4500
Mailing Address - Fax:
Practice Address - Street 1:40 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9700
Practice Address - Country:US
Practice Address - Phone:910-295-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7980756Medicaid
NC80756OtherBCBS
NC0513260001Medicare NSC
NC2314309Medicare PIN
NC7980756Medicaid