Basic Information
| Provider Information | |||||||||
| NPI: | 1619273802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEE DEE ORTHOPEDIC ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E CHEVES ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436625233 | ||||||||
| FaxNumber: | 8436789003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1604 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283525524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102764611 | ||||||||
| FaxNumber: | 9102774244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2011 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | WILLIE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8436625233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PEE DEE ORTHOPAEDIC ASSOCIATES, P.A. | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.