Provider Demographics
NPI:1285701482
Name:ORTHOPEDIC CENTER PC
Entity type:Organization
Organization Name:ORTHOPEDIC CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLEINPETER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:912-644-5300
Mailing Address - Street 1:1601 FAIR RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0801
Mailing Address - Country:US
Mailing Address - Phone:912-681-6747
Mailing Address - Fax:
Practice Address - Street 1:1601 FAIR RD STE 1100
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0801
Practice Address - Country:US
Practice Address - Phone:912-681-6747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)