Provider Demographics
NPI:1447289731
Name:CARY ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, P.A.
Entity type:Organization
Organization Name:CARY ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-4992
Mailing Address - Street 1:PO BOX 63086
Mailing Address - Street 2:DEPT. 4086
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3086
Mailing Address - Country:US
Mailing Address - Phone:919-467-4992
Mailing Address - Fax:919-235-0134
Practice Address - Street 1:1120 SE CARY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-467-4992
Practice Address - Fax:919-235-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01919OtherBCBS
NC0266180001Medicare NSC