Provider Demographics
NPI:1689694481
Name:WNC SPINE SURGERY PA
Entity Type:Organization
Organization Name:WNC SPINE SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-452-8346
Mailing Address - Street 1:262 LEROY GEORGE DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7430
Mailing Address - Country:US
Mailing Address - Phone:828-452-8378
Mailing Address - Fax:828-452-8326
Practice Address - Street 1:262 LEROY GEORGE DR
Practice Address - Street 2:SUITE M
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7430
Practice Address - Country:US
Practice Address - Phone:828-452-8378
Practice Address - Fax:828-452-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200143174400000X
NC200600993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC132WCOtherBCBS OF NC GROUP NUMBER
NC5950658Medicaid
NC5104400001Medicare NSC
NC233090Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER