Basic Information
| Provider Information | |||||||||
| NPI: | 1720291545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC SPECIALISTS OF CHARLESTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2093 HENRY TECKLENBURG DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439582500 | ||||||||
| FaxNumber: | 8439582635 | ||||||||
| Practice Location | |||||||||
| Address1: | 2891 TRICOM ST STE A | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294067110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439582500 | ||||||||
| FaxNumber: | 8435695931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 09/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | GRAHAM | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8439582500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.