Provider Demographics
NPI:1568797900
Name:WESTERN CAROLINA PHYSICIAN NETWORK INC
Entity Type:Organization
Organization Name:WESTERN CAROLINA PHYSICIAN NETWORK INC
Other - Org Name:HAYWOOD MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-452-8210
Mailing Address - Street 1:16 PHYSICIAN DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8486
Mailing Address - Country:US
Mailing Address - Phone:828-456-9836
Mailing Address - Fax:828-452-9225
Practice Address - Street 1:16 PHYSICIAN DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8486
Practice Address - Country:US
Practice Address - Phone:828-456-9836
Practice Address - Fax:828-452-9814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN CAROLINA PHYSICIAN NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912802Medicaid
NC5912802Medicaid