Provider Demographics
NPI:1770678591
Name:STACK, PHILIP EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:EDWARD
Last Name:STACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WESTCARE DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5278
Mailing Address - Country:US
Mailing Address - Phone:828-586-9200
Mailing Address - Fax:828-586-7459
Practice Address - Street 1:26 WESTCARE DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5278
Practice Address - Country:US
Practice Address - Phone:828-586-9200
Practice Address - Fax:828-586-7459
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400644207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79118OtherBLUE CROSS BLUE SHEILD
NC8979118Medicaid
NCF82873Medicare UPIN
NC79118OtherBLUE CROSS BLUE SHEILD