MEDICARE: ORTHOPAEDIC CENTER OF THE CAROLINAS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841268943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC CENTER OF THE CAROLINAS, PA

Provider Business Mailing Address
First Line	:	PO BOX 25039
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29616-0039
Country	:	US
Telephone Number	:	864-850-1968
Fax Number	:	864-850-1707

Provider Business Practice Location Address
First Line	:	100 POWERS BLVD
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673
Country	:	US
Telephone Number	:	864-850-1968
Fax Number	:	864-850-1707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM L DEVAULT
Credential	:	MD
Telephone Number	:	864-850-1968

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/01/2008

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Directions to “ORTHOPAEDIC CENTER OF THE CAROLINAS, PA ” Practice Location

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