MEDICARE: ORTHOCAROLINA, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	28865	NC
2	207X00000X	Orthopaedic Surgery Physician	28865	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194167338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOCAROLINA, PA

Provider Business Mailing Address
First Line	:	4601 PARK RD
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3239
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 W PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. BRENT SHEAR
Credential	:
Telephone Number	:	704-323-2000

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	07/29/2013

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Directions to “ORTHOCAROLINA, PA ” Practice Location

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