Provider Demographics
NPI:1063499838
Name:WESTERN CAROLINA FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:WESTERN CAROLINA FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:CARLSON
Authorized Official - Last Name:SPIES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-274-6610
Mailing Address - Street 1:1257 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1916
Mailing Address - Country:US
Mailing Address - Phone:828-274-6610
Mailing Address - Fax:828-274-6670
Practice Address - Street 1:1257 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1916
Practice Address - Country:US
Practice Address - Phone:828-274-6610
Practice Address - Fax:828-274-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76916OtherBCBS
NC8976916Medicaid
NC76916OtherBCBS
G38097Medicare UPIN