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General NPI Number Information
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NPI Number | 1215184924
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLE ORTHOPAEDIC CLINIC, PA
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 300 E. MCKAY STREET SUITE E
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-9037
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Country | US
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Telephone | 910-484-3114
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Fax | 910-484-8824
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Provider Business Mailing Address
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Address Line | 300 E. MCKAY STREET SUITE E
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-9037
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Country | US
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Telephone | 910-484-3114
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Fax | 910-484-8824
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Authorized Official
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Title or Position | PRACTICE ADMINISTRAT
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Name | MR. MARK J. MACEJKO
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Credential |
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Telephone | 910-223-2007
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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 |
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License Number State |
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