Provider Demographics
NPI:1356663421
Name:CAROLINA SPINE & NEUROSURGERY CENTER PA
Entity Type:Organization
Organization Name:CAROLINA SPINE & NEUROSURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-255-7776
Mailing Address - Street 1:PO BOX 25370
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28813-1370
Mailing Address - Country:US
Mailing Address - Phone:828-255-7776
Mailing Address - Fax:828-274-5134
Practice Address - Street 1:92 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3010
Practice Address - Country:US
Practice Address - Phone:828-255-7776
Practice Address - Fax:828-274-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0509Medicare PIN