Healthcare Provider Details

I. General information

NPI: 1700185998
Provider Name (Legal Business Name): ORTHOCAROLINA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 COPPERFIELD BLVD NE
CONCORD NC
28025-2402
US

IV. Provider business mailing address

PO BOX 602179
CHARLOTTE NC
28260-2179
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2000
  • Fax:
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number38865
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38865
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number38865
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number38865
License Number StateNC

VIII. Authorized Official

Name: MR. BRENT SHEAR
Title or Position: CFO
Credential:
Phone: 704-323-2000