Provider Demographics
NPI:1275592677
Name:BOILING SPRINGS MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:BOILING SPRINGS MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-434-0365
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28017-0815
Mailing Address - Country:US
Mailing Address - Phone:704-434-0365
Mailing Address - Fax:704-434-2801
Practice Address - Street 1:305 W. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28017-0815
Practice Address - Country:US
Practice Address - Phone:704-434-0365
Practice Address - Fax:704-434-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32231261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901123Medicaid
NC8901123Medicaid
NC2310826Medicare ID - Type UnspecifiedGROUP