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General NPI Number Information
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NPI Number | 1205024007
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Entity Type | Organization
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Legal Business Name | CENTRAL CAROLINA ORTHOPAEDIC
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Dates
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Enumeration Date | 10/07/2007
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1139 CARTHAGE ST SUITE 101
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City | SANFORD
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State | NC
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Zip | 27330-4111
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Country | US
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Telephone | 919-774-1355
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Fax | 919-775-1644
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Provider Business Mailing Address
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Address Line | PO BOX 3247
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City | SANFORD
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State | NC
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Zip | 27331-3247
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Country | US
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Telephone | 919-774-1355
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Fax | 919-775-1644
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW P BUSH
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Credential | MD
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Telephone | 919-774-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9500524
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License Number State | NC
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