Provider Demographics
NPI:1316924632
Name:CAROLINA BONE & JOINT SURGERY CENTER
Entity type:Organization
Organization Name:CAROLINA BONE & JOINT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-903-6320
Mailing Address - Street 1:101 SURGEONS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5198
Mailing Address - Country:US
Mailing Address - Phone:843-236-6633
Mailing Address - Fax:843-903-6331
Practice Address - Street 1:101 SURGEONS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5198
Practice Address - Country:US
Practice Address - Phone:843-236-6633
Practice Address - Fax:843-903-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF077207X00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC052Medicaid
Q333980001Medicare ID - Type Unspecified
SCASC052Medicaid