Provider Demographics
NPI:1770546293
Name:SHELBY BONE AND JOINT CLINIC, P.A.
Entity type:Organization
Organization Name:SHELBY BONE AND JOINT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YVES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-482-7311
Mailing Address - Street 1:807 SCHENCK ST, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3933
Mailing Address - Country:US
Mailing Address - Phone:704-482-7311
Mailing Address - Fax:704-487-0339
Practice Address - Street 1:807 SCHENCK ST STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5123
Practice Address - Country:US
Practice Address - Phone:704-482-7311
Practice Address - Fax:704-487-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0181340001Medicare NSC