Healthcare Provider Details

I. General information

NPI: 1528063120
Provider Name (Legal Business Name): BREVARD ORTHOPAEDICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CHESTNUT ST STE. 2
BREVARD NC
28712-3010
US

IV. Provider business mailing address

316 CHESTNUT ST STE. 2
BREVARD NC
28712-3010
US

V. Phone/Fax

Practice location:
  • Phone: 828-884-2055
  • Fax: 828-884-2834
Mailing address:
  • Phone: 828-884-2055
  • Fax: 828-884-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. AMY J GOOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-884-2055