Provider Demographics
NPI:1467435040
Name:WNC INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:WNC INTERNAL MEDICINE, PLLC
Other - Org Name:WNC INTERNAL MEDICINE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-7796
Mailing Address - Street 1:98 COPE CREEK RD STE A-B
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-9508
Mailing Address - Country:US
Mailing Address - Phone:828-586-7798
Mailing Address - Fax:866-282-0679
Practice Address - Street 1:98 COPE CREEK RD STE A-B
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-9508
Practice Address - Country:US
Practice Address - Phone:828-586-7798
Practice Address - Fax:866-282-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20370207R00000X
NC00220208000000X
NC2005009762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011T8OtherBCBS PROVIDER NUMBER
NC89011T8Medicaid
NC=========OtherTAX ID#