Provider Demographics
NPI:1730246604
Name:CAROLINA ORTHOPAEDIC CLINIC, PC
Entity type:Organization
Organization Name:CAROLINA ORTHOPAEDIC CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-419-6646
Mailing Address - Street 1:710 RABON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8903
Mailing Address - Country:US
Mailing Address - Phone:803-419-6646
Mailing Address - Fax:803-419-6626
Practice Address - Street 1:710 RABON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8903
Practice Address - Country:US
Practice Address - Phone:803-534-7600
Practice Address - Fax:803-534-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5570Medicare ID - Type Unspecified
1192980001Medicare NSC