MEDICARE: PINEHURST ORTHOPEDIC GROUP, PA

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	207X00000X	Orthopaedic Surgery Physician	9901414	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB4068	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	12586	OTHER		BCBS NC

General Provider Information

NPI Number	:	1780765214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINEHURST ORTHOPEDIC GROUP, PA

Provider Business Mailing Address
First Line	:	4208 MURDOCKSVILLE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8871
Country	:	US
Telephone Number	:	910-295-7070
Fax Number	:	910-295-7447

Provider Business Practice Location Address
First Line	:	4208 MURDOCKSVILLE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8871
Country	:	US
Telephone Number	:	910-295-7070
Fax Number	:	910-295-7447

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. BJ GOODRIDGE
Credential	:	MHA
Telephone Number	:	910-295-7070

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/16/2016

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Directions to “PINEHURST ORTHOPEDIC GROUP, PA ” Practice Location

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