MEDICARE: CAROLINA ORTHOPEDIC AND SPORTS MEDICINE INC

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	225100000X	Physical Therapist	142144	NC
2	225X00000X	Occupational Therapist	142144	NC
3	207X00000X	Orthopaedic Surgery Physician	142144	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019K4	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972797520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA ORTHOPEDIC AND SPORTS MEDICINE INC

Provider Business Mailing Address
First Line	:	738 NEWMAN RD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5238
Country	:	US
Telephone Number	:	252-634-2676
Fax Number	:	252-633-3502

Provider Business Practice Location Address
First Line	:	3722 BRIDGES ST
Second Line	:	SUITE 202
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2944
Country	:	US
Telephone Number	:	252-634-2676
Fax Number	:	252-633-3502

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAWN D GARRETT
Credential	:
Telephone Number	:	252-634-2676

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/20/2008

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