Provider Demographics
NPI:1912102088
Name:EASLEY ORTHOPAEDIC CLINIC, PA
Entity Type:Organization
Organization Name:EASLEY ORTHOPAEDIC CLINIC, PA
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-855-4431
Mailing Address - Street 1:704 N A ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2142
Mailing Address - Country:US
Mailing Address - Phone:864-855-4431
Mailing Address - Fax:864-306-0012
Practice Address - Street 1:704 N A ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2142
Practice Address - Country:US
Practice Address - Phone:864-855-4431
Practice Address - Fax:864-306-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0529920001OtherMEDICARE DME
SCPC2083Medicaid
SCPC2083Medicaid
SC2177Medicare PIN