SOUTHEASTERN ORTHOPEDICS SPORTS MEDICINE & SHOULDER CENTER PA


Address: 3404 Wake Forest Rd, Ste 201, Raleigh, NC 27609-7341
Phone: 9192561511

SOUTHEASTERN ORTHOPEDICS SPORTS MEDICINE & SHOULDER CENTER PA (NPI# 1053367615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053367615
Entity Type Organization
Organization Name SOUTHEASTERN ORTHOPEDICS SPORTS MEDICINE & SHOULDER CENTER PA
Practice Address 3404 Wake Forest Rd
Ste 201
Raleigh
NC 27609-7341
Practice Telephone 9192561511
Practice Fax Number 9192561530
Mailing Telephone 9192561511
Mailing Fax Number 9192561530
Enumeration Date 2006-05-25
Last Update Date 2014-06-11
Authorized Official Name KEVIN P SPEER (PRESIDENT)
Authorized Official Telephone 9192561511
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
NC BCBS 015W4 01
US DEPT OF LABOR 154156200 01
NC MEDICAID 89015W4 01

Office Location

Street Address 3404 WAKE FOREST RD
STE 201
City RALEIGH
State NC
Zip Code 27609-7341

Providers in the same location

NPI Name Taxonomy Address Enumeration
1467455832 Jon Kolkin Orthopaedic Surgery 3404 Wake Forest Rd, Ste 303, Raleigh, NC 27609-7341 2005-05-31
1891283073 Regional Anesthesia, Pllc Specialist 3404 Wake Forest Rd, Raleigh, NC 27609-7340 2018-04-24
1023517745 Melissa Jo Peterson Nurse Practitioner 3404 Wake Forest Rd, Raleigh, NC 27609-7340 2018-02-08
1972054211 Claire Gere Reynolds Nurse Practitioner 3404 Wake Forest Rd, 202, Raleigh, NC 27609-7340 2016-10-21
1477920247 Jaclyn White Nurse Practitioner 3404 Wake Forest Rd, Suite 302, Raleigh, NC 27609-7340 2015-08-27
1790160745 Catherine Frances Sellers Nurse Practitioner 3404 Wake Forest Rd, Mob 7, Lower Level, Raleigh, NC 27609-7340 2015-07-20
1093057028 Stephanie Nicole Roberts Registered Nurse 3404 Wake Forest Rd, St 200, Raleigh, NC 27609-7340 2013-03-15
1942558705 Meaghan Thomas Occupational Therapy Assistant 3404 Wake Forest Rd, Suite 303, Raleigh, NC 27609-7340 2012-08-27
1306116611 Private Diagnostic Clinic, Pllc Obstetrics & Gynecology 3404 Wake Forest Rd, Suite 200, Raleigh, NC 27609-7340 2012-01-03
1477834349 Brittaney Swift Wolfe Nurse Practitioner 3404 Wake Forest Rd, Suite 203, Raleigh, NC 27609-7340 2011-09-06
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1184235582 Choice Service Solutions LLC In Home Supportive Care 5300 Six Fox Rd Siite205, Raleigh, NC 27609 2020-08-11
1003426073 Rosana Oba -rovira Registered Nurse 5300 Six Fox Road, Suite 205, Raleigh, NC 27609 2020-08-05
1821612706 Helen Alexandra Bonner Physical Medicine & Rehabilitation Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 2020-06-05
1215423579 Appiah Nana Larbi Social Worker Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 2018-07-10
1215423777 Broadway Home Care LLC In Home Supportive Care 107 Windel Dr Ste 105, Raleigh, NC 27609 2018-07-09
1275027948 Lacey Allene Cottingham Social Worker 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 2018-06-18
1447748819 Integrated Dermatology of North Raleigh, Pllc Dermatology 3809 Computer Dr Ste 200, Raleigh, NC 27609 2018-05-01
1902325418 Naomi Christine Askew Nurse Practitioner 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 2017-09-15
1962929679 Alexia Montague Social Worker 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 2017-08-23
1730602236 Chantel Washington-mbuthia Counselor 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 2017-07-18
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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1124586060 Bethany Christian Services of Nc Clinic/Center 1110 Navaho Dr Ste 109, Raleigh, NC 27609-7352 2019-03-11
1790202133 Healthworks Med Group of North Carolina P C Clinic/Center 337 S Salisbury St, Raleigh, NC 27601-1728 2017-08-25
1366553133 Brier Creek Family Practice, Pllc Clinic/Center 3721 Lynn Rd, Suite 104, Raleigh, NC 27613-3854 2006-08-31
1821650680 Med First Urgent Care, Pllc Clinic/Center 1616 E Millbrook Rd Ste 110, Raleigh, NC 27609-4971 2019-07-02
1427575869 Healthworks Med Group of North Carolina P C Clinic/Center 3010 Falstaff Rd, Raleigh, NC 27610-1813 2017-08-25
1558441659 University of North Carolina At Chapel Hill Clinic/Center 3000 New Bern Ave, Suite G-200, Raleigh, NC 27610-1231 2006-10-16

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1447851340 Be Inc Clinic/Center 13 N Kaufman Stone Way, Candler, NC 28715-7721 2020-11-06
1801424171 Recover Together, Inc. Clinic/Center 59 Haywood Office Park Ste 2, Waynesville, NC 28785-6998 2020-03-31
1891330056 Veritas Collaborative Charlotte, LLC Clinic/Center 1900 Scott Ave Ste 101, Charlotte, NC 28203-6046 2019-11-12
1770135808 American Family Care Fuquay Pllc Clinic/Center 1298 N Main St, Fuquay Varina, NC 27526-2615 2019-07-09
1508424029 Shelly Renea Obasoluyi Clinic/Center 403 Atwell Dr, Fayetteville, NC 28314-0122 2019-05-30
1215593819 Wilmington Health Pllc Clinic/Center 1811 Tiburon Dr, Wilmington, NC 28403-6254 2019-05-20
1003472804 Loginclinics, Pllc Clinic/Center 1324 Reservoir View Ln, Wake Forest, NC 27587-1836 2019-05-16
1548740038 Hillsborough Community Urgent Care Clinic/Center 110 Boone Square St Ste 29a, Hillsborough, NC 27278-2665 2018-08-15
1679079537 Carter Clinic, Pa Clinic/Center 260 1st Ave Nw Ste 215, Hickory, NC 28601-6161 2018-03-31
1356846406 Healthworks Med Group of North Carolina P C Clinic/Center 1040 E 3rd St, Siler City, NC 27344-7639 2018-03-29
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Competitor

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City RALEIGH
Zip Code 27609

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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