Provider Demographics
NPI:1720084981
Name:LEXINGTON ORTHOPEDIC CLINIC PA
Entity Type:Organization
Organization Name:LEXINGTON ORTHOPEDIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-249-2978
Mailing Address - Street 1:510 EMERGENCY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6804
Mailing Address - Country:US
Mailing Address - Phone:336-249-2978
Mailing Address - Fax:336-249-6748
Practice Address - Street 1:510 EMERGENCY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6804
Practice Address - Country:US
Practice Address - Phone:336-249-2978
Practice Address - Fax:336-249-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
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
NC8902013Medicaid
NC0182010001OtherPALMETTO GROUP NUMBER
NC8902013Medicaid