Provider Demographics
NPI:1568581999
Name:PAUL J ENDRY
Entity Type:Organization
Organization Name:PAUL J ENDRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-253-3533
Mailing Address - Street 1:1 PAGE AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2382
Mailing Address - Country:US
Mailing Address - Phone:828-253-3533
Mailing Address - Fax:828-253-3389
Practice Address - Street 1:1 PAGE AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2382
Practice Address - Country:US
Practice Address - Phone:828-253-3533
Practice Address - Fax:828-253-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1206261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9266Medicaid
NC8909266Medicaid
NC5886180001Medicare NSC
NC8909266Medicaid