Provider Demographics
NPI:1831220060
Name:SCOTLAND ORTHOPEDICS, PA
Entity type:Organization
Organization Name:SCOTLAND ORTHOPEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-479-9033
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-0917
Mailing Address - Country:US
Mailing Address - Phone:843-479-9033
Mailing Address - Fax:843-479-8825
Practice Address - Street 1:209 BALL PARK ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-479-9033
Practice Address - Fax:843-479-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0639Medicaid
SC=========OtherSC BCBS
SC4285Medicare ID - Type UnspecifiedSC MEDICARE
SC0583630002Medicare NSC