=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124526355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUFF ORTHOPAEDIC GROUP, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2018
-----------------------------------------------------
Last Update Date | 03/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 BEAMAN ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28328-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-596-5633
-----------------------------------------------------
Fax | 910-596-0977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 BEAMAN ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28328-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-596-5633
-----------------------------------------------------
Fax | 910-596-0977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM ALEXANDER HUFF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 910-596-5633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 9800570
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------