Provider Demographics
NPI:1780765214
Name:PINEHURST ORTHOPEDIC GROUP, PA
Entity type:Organization
Organization Name:PINEHURST ORTHOPEDIC GROUP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:910-295-7070
Mailing Address - Street 1:4208 MURDOCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8871
Mailing Address - Country:US
Mailing Address - Phone:910-295-7070
Mailing Address - Fax:910-295-7447
Practice Address - Street 1:4208 MURDOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8871
Practice Address - Country:US
Practice Address - Phone:910-295-7070
Practice Address - Fax:910-295-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901414207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB4068OtherRAILROAD MEDICARE
NC8912586Medicaid
12586OtherBCBS NC
NC2335634Medicare PIN
12586OtherBCBS NC