Healthcare Provider Details

I. General information

NPI: 1124070115
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALISTS OF THE CAROLINAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 KIMEL PARK DR
WINSTON SALEM NC
27103-6946
US

IV. Provider business mailing address

PO BOX 25626
WINSTON SALEM NC
27114-5626
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-1270
  • Fax: 336-765-6375
Mailing address:
  • Phone: 336-768-1270
  • Fax: 336-765-6375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA A HAYES
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 336-659-4111