Carolina Orthopaedic and Sports Medicine, P.a.

Organization Active NPI Orthopaedic Surgery Physician · Columbia, SC

NPI 1922055649 · NPPES record last updated Apr 10, 2013

Key facts

NPI
1922055649
Entity type
Organization (NPI type 2)
Primary specialty
Orthopaedic Surgery Physician 207X00000X
Legal business name
CAROLINA ORTHOPAEDIC AND SPORTS MEDICINE, P.A.
Practice address
1818 Henderson St
Columbia, SC 29201-2619
Phone
(803) 758-2600
Fax
(803) 253-8896
NPI assigned
May 28, 2006
Organization subpart
No

Authorized official

Name
David Boucher
Title
President and Coo
Phone
(803) 782-4278

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207X00000X SC Yes

Addresses

Primary practice location

1818 Henderson St
Columbia, SC 29201-2619

Mailing address

PO Box 890046
Charlotte, NC 28289-0046
Phone (803) 758-2600

Other identifiers

IdentifierTypeStateIssuer
GP4222MedicaidSC

Other providers in Columbia, SC

All providers in Columbia, SC · Orthopaedic Surgery Physician in South Carolina

Sources for this page

Verify at the official NPI Registry.