Provider Demographics
NPI:1790870830
Name:WESTERN CAROLINA DIGESTIVE CONSULTANTS PA
Entity Type:Organization
Organization Name:WESTERN CAROLINA DIGESTIVE CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:KNOP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-586-9200
Mailing Address - Street 1:26 WESTCARE DRIVE
Mailing Address - Street 2:SUITE 304
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 304
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890292KMedicaid
NC0292KOtherBLUECROSS BLUESHEILD
NC2317553Medicare ID - Type Unspecified