Organization
NORTHEAST ORTHOPEDICS PA
Active
Organization
NORTHEAST ORTHOPEDICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE WILLIAM THOMPSON MA MBA (ADMINISTRATOR)
(704) 788-3155
Entity
Organization
Contact information
Practice address
354 COPPERFIELD BLVD, NE, CONCORD, NC 28025-2402
(704) 788-3155
(704) 785-8302
Mailing address
PO BOX 1606, CONCORD, NC 28026-6002
(704) 788-3155
(704) 785-8302
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02666
BCBS
—
01
—
3683
PARTNERS MCARE
—
05
—
8902666
—
NC
01
—
CG1491
RAILROAD MEDICARE
—
Enumeration date
03/23/2006
Last updated
12/03/2008
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