Provider Demographics
NPI:1154322063
Name:PILOT MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PILOT MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-368-2232
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:4804 NC HWY 268 EAST
Mailing Address - City:PILOT MTN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-0280
Mailing Address - Country:US
Mailing Address - Phone:336-368-2232
Mailing Address - Fax:336-368-2232
Practice Address - Street 1:213C E MARION ST
Practice Address - Street 2:
Practice Address - City:PILOT MTN
Practice Address - State:NC
Practice Address - Zip Code:27041-8535
Practice Address - Country:US
Practice Address - Phone:336-368-1070
Practice Address - Fax:336-368-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129N0Medicaid
NC89129N0Medicaid