| Southeastern Orthopedics Sports Medicine & Shoulder Center Pa | |
|
3404 Wake Forest Rd Ste 201 Raleigh NC 27609-7341 | |
| (919) 256-1511 | |
| (919) 256-1530 |
| Full Name | Southeastern Orthopedics Sports Medicine & Shoulder Center Pa |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 3404 Wake Forest Rd, Raleigh, North Carolina |
| Authorized Official Name and Position | Kevin P Speer (PRESIDENT) |
| Authorized Official Contact | 9192561511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Orthopedics Sports Medicine & Shoulder Center Pa 3404 Wake Forest Rd Ste 201 Raleigh NC 27609-7341 Ph: (919) 256-1511 | Southeastern Orthopedics Sports Medicine & Shoulder Center Pa 3404 Wake Forest Rd Ste 201 Raleigh NC 27609-7341 Ph: (919) 256-1511 |
| NPI Number | 1053367615 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 06/11/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053367615 | NPI | - | NPPES |
| 154156200 | Other | US DEPT OF LABOR | |
| 89015W4 | Other | NC | MEDICAID |
| 015W4 | Other | NC | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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