Provider Demographics
NPI:1336337062
Name:WRIGHT ORTHOPEDIC SPORTS MEDICINE AND FITNESS INSTITUTE PA
Entity Type:Organization
Organization Name:WRIGHT ORTHOPEDIC SPORTS MEDICINE AND FITNESS INSTITUTE PA
Other - Org Name:PAUL H WRIGHT MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-471-9331
Mailing Address - Street 1:4125 BEN FRANKLIN BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2167
Mailing Address - Country:US
Mailing Address - Phone:919-471-9331
Mailing Address - Fax:919-471-6524
Practice Address - Street 1:4125 BEN FRANKLIN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2167
Practice Address - Country:US
Practice Address - Phone:919-471-9331
Practice Address - Fax:919-471-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19430207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890195XMedicaid
152990000OtherUS DEPT OF LABOR
NC2311807Medicare PIN
152990000OtherUS DEPT OF LABOR