Provider Demographics
NPI:1720245111
Name:KERR LAKE ORTHOPAEDICS
Entity Type:Organization
Organization Name:KERR LAKE ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-436-1101
Mailing Address - Street 1:120 CHARLES ROLLINS ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-436-1314
Mailing Address - Fax:
Practice Address - Street 1:120 CHARLES ROLLINS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2882
Practice Address - Country:US
Practice Address - Phone:252-436-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA PARHAM ANESTHESIA AND PHYSIARTY CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800411207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2022035Medicare PIN