Provider Demographics
NPI:1205924669
Name:BOONE ORTHOPAEDIC ASSOCIATES, P.A.
Entity type:Organization
Organization Name:BOONE ORTHOPAEDIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J. MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:KADYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-1100
Mailing Address - Street 1:194 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5000
Mailing Address - Country:US
Mailing Address - Phone:828-264-1100
Mailing Address - Fax:828-264-0113
Practice Address - Street 1:194 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5000
Practice Address - Country:US
Practice Address - Phone:828-264-1100
Practice Address - Fax:828-264-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901128Medicaid
NC8901128Medicaid