Provider Demographics
NPI:1306644521
Name:CAROLINA ORTHOPAEDIC & SPORTS MEDICINE CENTER PA
Entity type:Organization
Organization Name:CAROLINA ORTHOPAEDIC & SPORTS MEDICINE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-865-0077
Mailing Address - Street 1:2345 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2151
Mailing Address - Country:US
Mailing Address - Phone:704-865-0077
Mailing Address - Fax:704-867-6401
Practice Address - Street 1:210 BEATTY DR STE 100
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2716
Practice Address - Country:US
Practice Address - Phone:704-266-3100
Practice Address - Fax:704-867-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies