Provider Demographics
NPI:1902874019
Name:ORTHOPAEDIC CENTER OF THE CAROLINAS, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC CENTER OF THE CAROLINAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEVAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-676-0897
Mailing Address - Street 1:PO BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-676-0897
Mailing Address - Fax:864-676-0898
Practice Address - Street 1:135 COMMONWEALTH DR
Practice Address - Street 2:SUITE 230
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4831
Practice Address - Country:US
Practice Address - Phone:864-676-0897
Practice Address - Fax:864-676-0898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS PHYSICIAN SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1500Medicaid
SC8157Medicare PIN