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NPI Code Detail

MEDICARE: GEORGETOWN ORTHOPAEDICS, LLC

MEDICARE: GEORGETOWN ORTHOPAEDICS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1548549017
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGETOWN ORTHOPAEDICS, LLC
Provider Business Mailing Address
First Line : 2185 N FRASER ST
Second Line :
City : GEORGETOWN
State : SC
Zip : 29440-6418
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2185 N FRASER ST
Second Line :
City : GEORGETOWN
State : SC
Zip : 29440-6418
Country : US
Telephone Number : 843-325-1315
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : DEANNE OWENS
Credential :
Telephone Number : 843-325-1315
Provider Enumeration Date : 08/15/2011
Last Update Date : 08/15/2011

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Directions to “GEORGETOWN ORTHOPAEDICS, LLC ” Practice Location

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