Provider Demographics
NPI:1255425443
Name:JOHNSTON ORTHOPAEDIC CENTER
Entity type:Organization
Organization Name:JOHNSTON ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYLCIW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-934-1094
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:540 NORTH ST
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-1538
Mailing Address - Country:US
Mailing Address - Phone:919-934-1094
Mailing Address - Fax:919-934-9044
Practice Address - Street 1:540 NORTH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-934-1094
Practice Address - Fax:919-934-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26207207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890181AMedicaid
1238Medicare ID - Type UnspecifiedGROUP
NC0766580001Medicare NSC
NC1255425443Medicare NSC
C87430Medicare UPIN
205196Medicare ID - Type Unspecified