Provider Demographics
NPI:1306251533
Name:SOUTHEASTERN ORTHOPAEDIC SPECIALISTS, P.A.
Entity type:Organization
Organization Name:SOUTHEASTERN ORTHOPAEDIC SPECIALISTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARIZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-375-2300
Mailing Address - Street 1:1130 N CHURCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1041
Mailing Address - Country:US
Mailing Address - Phone:336-375-2300
Mailing Address - Fax:336-375-2314
Practice Address - Street 1:640 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5320
Practice Address - Country:US
Practice Address - Phone:336-623-0973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty