1629005517 NPI number — CATAWBA VALLEY NEUROSURGICAL & SPINE SERVICES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629005517 NPI number — CATAWBA VALLEY NEUROSURGICAL & SPINE SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATAWBA VALLEY NEUROSURGICAL & SPINE SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629005517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 TATE BLVD SE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28602-4042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-327-6499
Provider Business Mailing Address Fax Number:
828-327-9902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 TATE BLVD SE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-4042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-327-6499
Provider Business Practice Location Address Fax Number:
828-327-9902
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLOSKEY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
828-327-6433

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7902368 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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