Provider Demographics
NPI:1013109842
Name:ATLANTIC COAST NEUROSURGERY INC
Entity Type:Organization
Organization Name:ATLANTIC COAST NEUROSURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-344-3433
Mailing Address - Street 1:2107 ROSALIND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-344-3433
Mailing Address - Fax:540-344-3358
Practice Address - Street 1:2107 ROSALIND AVENUE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-344-3433
Practice Address - Fax:540-344-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042165207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE8364OtherMEDICARE RAILROAD
VAC09822OtherMEDICARE GROUP #