NPIMap

Organization Active NPI

Carrollton Orthopaedic Clinic PC

  • Pharmacy
  • Carrollton, GA
National Provider Identifier
1912367111
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
038964 Issued in GA
Legal business name
CARROLLTON ORTHOPAEDIC CLINIC PC
Practice address
812 S Park St Ste 3
Carrollton, GA 30117-4412
Phone
(727) 755-0693
NPI assigned
Mar 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Gilbert
Title
Cfo
Phone
(727) 755-0693

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 038964 GA Primary
Clinic Pharmacy 3336C0002X

Addresses

Primary practice location

812 S Park St Ste 3
Carrollton, GA 30117-4412

Mailing address

311 Park Place Blvd
Suite 500
Clearwater, FL 33759-4904
Phone (727) 755-0693

Other identifiers 2

IdentifierTypeStateIssuer
2158456OtherPK
000104427MedicaidGA

Other names 1

  • Carrollton Orthopaedic Clinic Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2021186Carrollton Orthopaedic Clinic Spine and MRI Ctr812 South Park Street, Suite 3, Carrollton, GA 30117Certificate of waiverMar 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Carrollton Ortho Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1912367111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PARK PLACE BLVD",
            "address_2": "SUITE 500",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337594904",
            "telephone_number": "727-755-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 S PARK ST STE 3",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174412",
            "telephone_number": "727-755-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLLTON ORTHOPAEDIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-01",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "727-755-0693"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "038964",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158456",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000104427",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carrollton Orthopaedic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.