MEDICARE: CAROLINA BONE & JOINT SURGERY CENTER

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	207X00000X	Orthopaedic Surgery Physician	ASF077	SC
2	261QA1903X	Ambulatory Surgical Clinic/Center	ASF077	SC

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	:	1316924632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA BONE & JOINT SURGERY CENTER

Provider Business Mailing Address
First Line	:	101 SURGEONS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-5198
Country	:	US
Telephone Number	:	843-236-6633
Fax Number	:	843-903-6331

Provider Business Practice Location Address
First Line	:	101 SURGEONS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-5198
Country	:	US
Telephone Number	:	843-236-6633
Fax Number	:	843-903-6331

Authorized Official
Title or Position	:	CENTER DIRECTOR
Name	:	PAMELA SKIPPER
Credential	:	RN
Telephone Number	:	843-903-6320

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	06/18/2015

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