Provider Demographics
NPI:1457467771
Name:KANNAPOLIS SPINE & REHAB, INC.
Entity Type:Organization
Organization Name:KANNAPOLIS SPINE & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:704-938-1400
Mailing Address - Street 1:1909 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6107
Mailing Address - Country:US
Mailing Address - Phone:704-938-1400
Mailing Address - Fax:704-938-5892
Practice Address - Street 1:1909 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6107
Practice Address - Country:US
Practice Address - Phone:704-938-1400
Practice Address - Fax:704-938-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346653Medicare PIN