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General NPI Number Information
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NPI Number | 1437684453
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Entity Type | Organization
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Legal Business Name | SPECIALTY ORTHOPAEDICS AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 130 CRISANTO AVENUE SUITE B
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City | FORT MILL
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State | SC
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Zip | 29715
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Country | US
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Telephone | 803-548-6464
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Fax | 803-396-8440
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Provider Business Mailing Address
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Address Line | 130 CRISANTO AVENUE SUITE B
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City | FORT MILL
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State | SC
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Zip | 29715
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Country | US
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Telephone | 803-548-6464
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Fax | 803-396-8440
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. GLEN T FELTHAM
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Credential | M.D.
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Telephone | 570-452-0097
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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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