Provider Demographics
NPI:1962659045
Name:TRIANGLE SPINE & SPORTS MEDICINE
Entity Type:Organization
Organization Name:TRIANGLE SPINE & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARI
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUNCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-335-0911
Mailing Address - Street 1:1051 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE102
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4267
Mailing Address - Country:US
Mailing Address - Phone:919-335-0911
Mailing Address - Fax:919-362-6911
Practice Address - Street 1:1051 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4267
Practice Address - Country:US
Practice Address - Phone:919-335-0911
Practice Address - Fax:919-362-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401089261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138TJMedicaid
NCH21810Medicare UPIN
NC89138TJMedicaid
NC2036467Medicare PIN