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Organization

SOUTHEASTERN ORTHOPEDICS SPORTS MEDICINE & SHOULDER CENTER PA

Active
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Organization

SOUTHEASTERN ORTHOPEDICS SPORTS MEDICINE & SHOULDER CENTER PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KEVIN P SPEER MD (PRESIDENT)
(919) 256-1511
Entity
Organization

Contact information

Practice address
3404 WAKE FOREST RD, STE 201, RALEIGH, NC 27609-7341
(919) 256-1511
(919) 256-1530
Mailing address
3404 WAKE FOREST RD, STE 201, RALEIGH, NC 27609-7341
(919) 256-1511
(919) 256-1530

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
015W4
BCBS
NC
01
154156200
US DEPT OF LABOR
01
89015W4
MEDICAID
NC
Enumeration date
05/25/2006
Last updated
06/11/2014
Update your record

If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.

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