Provider Demographics
NPI:1417910480
Name:ROCKY MOUNT NEUROSURGICAL AND SPINE CONSULTANTS, PA
Entity Type:Organization
Organization Name:ROCKY MOUNT NEUROSURGICAL AND SPINE CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-443-4563
Mailing Address - Street 1:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0546
Mailing Address - Country:US
Mailing Address - Phone:252-443-4563
Mailing Address - Fax:252-443-6461
Practice Address - Street 1:2412 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2253
Practice Address - Country:US
Practice Address - Phone:252-443-4563
Practice Address - Fax:252-443-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7928297Medicaid
NC8954532Medicaid
NCE0043Medicare UPIN
NC7928297Medicaid
NC202379AMedicare ID - Type Unspecified
NC8954532Medicaid