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
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