Basic Information
| Provider Information | |||||||||
| NPI: | 1821128877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTLAND ORTHOPEDICS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 189 | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283530189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102764611 | ||||||||
| FaxNumber: | 9102774244 | ||||||||
| Practice Location | |||||||||
| Address1: | 1604 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283525524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102764611 | ||||||||
| FaxNumber: | 9102774244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 09/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | RUSH | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | FLETCHER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9102764611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 0217C | 01 | NC | NC BCBS | OTHER | 890217C | 05 | NC | MEDICAID |