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General NPI Number Information
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NPI Number | 1780765214
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Entity Type | Organization
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Legal Business Name | PINEHURST ORTHOPEDIC GROUP, PA
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 4208 MURDOCKSVILLE RD
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City | WEST END
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State | NC
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Zip | 27376-8871
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Country | US
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Telephone | 910-295-7070
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Fax | 910-295-7447
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Provider Business Mailing Address
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Address Line | 4208 MURDOCKSVILLE RD
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City | WEST END
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State | NC
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Zip | 27376-8871
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Country | US
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Telephone | 910-295-7070
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Fax | 910-295-7447
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. BJ GOODRIDGE
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Credential | MHA
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Telephone | 910-295-7070
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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 | 9901414
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License Number State | NC
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