Provider Demographics
NPI:1932750304
Name:ORTHOCAROLINA, PA - BUNDLE PAYMENT PROGRAM LEVEL 5
Entity Type:Organization
Organization Name:ORTHOCAROLINA, PA - BUNDLE PAYMENT PROGRAM LEVEL 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-323-2222
Mailing Address - Street 1:PO BOX 117444
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7444
Mailing Address - Country:US
Mailing Address - Phone:704-323-2250
Mailing Address - Fax:704-945-7679
Practice Address - Street 1:4601 PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2290
Practice Address - Country:US
Practice Address - Phone:704-323-2256
Practice Address - Fax:704-945-7681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOCAROLINA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty