MEDICARE: PRESBYTERIAN ORTHOPAEDIC HOSPITAL

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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1659300838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN ORTHOPAEDIC HOSPITAL

Provider Business Mailing Address
First Line	:	2085 FRONTIS PLAZA BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5614
Country	:	US
Telephone Number	:	336-277-7226
Fax Number	:	336-277-9795

Provider Business Practice Location Address
First Line	:	400 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2610
Country	:	US
Telephone Number	:	704-716-6181
Fax Number	:

Authorized Official
Title or Position	:	EVP/CFO
Name	:	FRED M HARGETT
Credential	:
Telephone Number	:	704-384-5184

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	11/18/2010

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