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General NPI Number Information
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NPI Number | 1487223814
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Entity Type | Organization
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Legal Business Name | ORTHONC ASC, LLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 11221 GALLERIA AVE STE 105
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City | RALEIGH
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State | NC
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Zip | 27614-8137
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Country | US
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Telephone | 919-562-9410
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | WAKE FOREST
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State | NC
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Zip | 27588-1107
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Country | US
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Telephone | 919-562-9410
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | MRS. LISA JOHNSON
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Credential |
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Telephone | 919-562-9410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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