Provider Demographics
NPI:1679503338
Name:SPEAR CLINIC PA
Entity Type:Organization
Organization Name:SPEAR CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-644-7771
Mailing Address - Street 1:1007-G HIGHWAY 150 WEST
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9772
Mailing Address - Country:US
Mailing Address - Phone:336-644-7771
Mailing Address - Fax:336-644-6118
Practice Address - Street 1:1007-G HIGHWAY 150 WEST
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9772
Practice Address - Country:US
Practice Address - Phone:336-644-7771
Practice Address - Fax:336-644-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401343261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903480Medicaid
NC5745110001Medicare NSC
NCG32862Medicare UPIN
NC5903480Medicaid