Healthcare Provider Details

I. General information

NPI: 1225221997
Provider Name (Legal Business Name): ORTHOPEDIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MALLETT WAY
BLUFFTON SC
29910-6064
US

IV. Provider business mailing address

7 MALLETT WAY
BLUFFTON SC
29910-6064
US

V. Phone/Fax

Practice location:
  • Phone: 800-827-6536
  • Fax:
Mailing address:
  • Phone: 800-827-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A. SIDWELL
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 912-644-5372