=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225073430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRALINA ORTHOPAEDIC AND SPORTS MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2006
-----------------------------------------------------
Last Update Date | 08/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 MOCKSVILLE AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-633-6044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 MOCKSVILLE AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-633-6044
-----------------------------------------------------
Fax | 704-633-9377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM S FURR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 704-633-6044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 33453
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------