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General NPI Number Information
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NPI Number | 1104917400
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Entity Type | Organization
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Legal Business Name | CAROLINA ORTHOPAEDIC SURGERY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 10/31/2013
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Provider Practice Location Address
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Address Line | 134 PROFESSIONAL PARK DR
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City | ROCK HILL
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State | SC
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Zip | 29732-1178
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Country | US
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Telephone | 803-329-7402
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Fax | 803-329-2611
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Provider Business Mailing Address
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Address Line | 134 PROFESSIONAL PARK DR
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City | ROCK HILL
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State | SC
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Zip | 29732-1178
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Country | US
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Telephone | 803-329-7402
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Fax | 803-329-2611
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARY F ELKINS
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Credential |
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Telephone | 803-329-7402
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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 | 11477
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License Number State | SC
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