Provider Demographics
NPI:1518047539
Name:TSAI, GEORGE S C (M D)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S C
Last Name:TSAI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S. INDIAN TRAIL ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079
Mailing Address - Country:US
Mailing Address - Phone:704-821-7056
Mailing Address - Fax:704-821-7057
Practice Address - Street 1:301 SOUTH INDIAN TRAIL ROAD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-0430
Practice Address - Country:US
Practice Address - Phone:704-821-7056
Practice Address - Fax:775-251-4575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01856OtherBLUE CROSS BLUE SHIELD
NC8901856Medicaid
NC0893Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NCC86836Medicare UPIN