Healthcare Provider Details

I. General information

NPI: 1568454056
Provider Name (Legal Business Name): CAROLINA ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOILING SPRINGS RD STE 1600
SPARTANBURG SC
29303-2244
US

IV. Provider business mailing address

1330 BOILING SPRINGS RD STE 1600
SPARTANBURG SC
29303-2244
US

V. Phone/Fax

Practice location:
  • Phone: 864-582-6396
  • Fax: 864-582-1608
Mailing address:
  • Phone: 864-582-6396
  • Fax: 864-582-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1028
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1157
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number11210
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17900
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number16064
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number13517
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number10774
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number26630
License Number StateSC
# 9
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberA153
License Number StateSC
# 10
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberA843
License Number StateSC
# 11
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number860
License Number StateSC
# 12
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10436
License Number StateSC

VIII. Authorized Official

Name: KAREN D WALCHER
Title or Position: OFFICE MANAGER
Credential: BS
Phone: 864-582-6396