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General NPI Number Information
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NPI Number | 1033139886
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA ORTHOPAEDIC SURGEONS PA
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 237 WHITE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-353-1437
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Fax | 910-353-5398
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Provider Business Mailing Address
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Address Line | 237 WHITE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-353-1437
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Fax | 910-353-5398
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL C MCCLURG
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Credential | MD PHD
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Telephone | 910-353-1437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 20030067
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License Number State | NC
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