Provider Demographics
NPI:1104917400
Name:CAROLINA ORTHOPAEDIC SURGERY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:CAROLINA ORTHOPAEDIC SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-329-7402
Mailing Address - Street 1:134 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1178
Mailing Address - Country:US
Mailing Address - Phone:803-329-7402
Mailing Address - Fax:803-329-2611
Practice Address - Street 1:134 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1178
Practice Address - Country:US
Practice Address - Phone:803-329-7402
Practice Address - Fax:803-329-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11477207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC0637Medicaid
SCB92346Medicare UPIN
SCC60868Medicare UPIN
SC0888210002Medicare NSC
SCG27979Medicare UPIN
SCB65323Medicare UPIN
SCD84448Medicare UPIN
SCPC0637Medicaid
SCB92661Medicare UPIN
SC2550Medicare ID - Type UnspecifiedGROUP NUMBER
SCB91669Medicare UPIN