Provider Demographics
NPI:1013167626
Name:TOTAL HEALTH ACUTE TREATMENT
Entity Type:Organization
Organization Name:TOTAL HEALTH ACUTE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEVIRGILIIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-262-3733
Mailing Address - Street 1:381 DEERFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5009
Mailing Address - Country:US
Mailing Address - Phone:828-262-3733
Mailing Address - Fax:828-262-3819
Practice Address - Street 1:381 DEERFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5009
Practice Address - Country:US
Practice Address - Phone:828-262-3733
Practice Address - Fax:828-262-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28719207Q00000X
NC33034207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928376Medicaid
NC7931142Medicaid
NCC87741Medicare UPIN
NC7931142Medicaid
NCC73333Medicare UPIN
NC8928376Medicaid