Healthcare Provider Details

I. General information

NPI: 1841268943
Provider Name (Legal Business Name): ORTHOPAEDIC CENTER OF THE CAROLINAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWERS BLVD
PIEDMONT SC
29673
US

IV. Provider business mailing address

PO BOX 25039
GREENVILLE SC
29616-0039
US

V. Phone/Fax

Practice location:
  • Phone: 864-850-1968
  • Fax: 864-850-1707
Mailing address:
  • Phone: 864-850-1968
  • Fax: 864-850-1707

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: WILLIAM L DEVAULT
Title or Position: PRESIDENT
Credential: MD
Phone: 864-850-1968