Healthcare Provider Details

I. General information

NPI: 1306893029
Provider Name (Legal Business Name): ASHEBORO ORTHOPEDIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542B WHITE OAK ST
ASHEBORO NC
27203-4710
US

IV. Provider business mailing address

542B WHITE OAK ST
ASHEBORO NC
27203-4710
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-4171
  • Fax: 336-629-4345
Mailing address:
  • Phone: 336-629-4171
  • Fax: 336-629-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA LOWDER HAYWOOD
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 336-629-4171