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Organization

SPECIALTY ORTHOPAEDICS AND SPORTS MEDICINE, LLC

Active
Other names
SpecOrtho
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GLEN T FELTHAM M.D. (OWNER, PHYSICIAN)
(570) 452-0097
Entity
Organization

Contact information

Practice address
130 CRISANTO AVENUE, SUITE B, FORT MILL, SC 29715
(803) 548-6464
(803) 396-8440
Mailing address
130 CRISANTO AVENUE, SUITE B, FORT MILL, SC 29715
(803) 548-6464
(803) 396-8440

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
G842
SC
Enumeration date
04/27/2017
Last updated
11/18/2020
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