Organization
CAROLINA ORTHOPAEDIC AND SPORTS MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BOUCHER (PRESIDENT AND COO)
(803) 782-4278
Entity
Organization
Contact information
Practice address
1818 HENDERSON ST, COLUMBIA, SC 29201-2619
(803) 758-2600
(803) 253-8896
Mailing address
PO BOX 890046, CHARLOTTE, NC 28289-0046
(803) 758-2600
(803) 253-8896
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4222
—
SC
Enumeration date
05/28/2006
Last updated
04/10/2013
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