Provider Demographics
NPI:1831142553
Name:CAROLINA CRANIOSPINAL NEUROSURGERY, LLC
Entity Type:Organization
Organization Name:CAROLINA CRANIOSPINAL NEUROSURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-637-9773
Mailing Address - Street 1:700A MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560
Mailing Address - Country:US
Mailing Address - Phone:252-638-4500
Mailing Address - Fax:252-637-2372
Practice Address - Street 1:700A MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560
Practice Address - Country:US
Practice Address - Phone:252-638-4500
Practice Address - Fax:252-637-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890170QMedicaid
NC0170QOtherBLUE CROSS BLUE SHIELD
NC2335779Medicare PIN