Provider Demographics
NPI:1124356019
Name:SALISBURY PEDIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:SALISBURY PEDIATRIC ASSOCIATES, PA
Other - Org Name:TOUCHSTONE HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEPARD
Authorized Official - Middle Name:SEWELL
Authorized Official - Last Name:AVERITT
Authorized Official - Suffix:IV
Authorized Official - Credentials:MED
Authorized Official - Phone:704-216-2020
Mailing Address - Street 1:129 WOODSON ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3255
Mailing Address - Country:US
Mailing Address - Phone:704-636-5576
Mailing Address - Fax:704-216-2011
Practice Address - Street 1:17810 STATESVILLE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8148
Practice Address - Country:US
Practice Address - Phone:704-655-6300
Practice Address - Fax:704-655-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902597Medicaid