1508372137 NPI number — MR. RYAN MICHAEL SPURLIN PA-C

Table of content: MR. RYAN MICHAEL SPURLIN PA-C (NPI 1508372137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508372137 NPI number — MR. RYAN MICHAEL SPURLIN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPURLIN
Provider First Name:
RYAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1508372137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4304
Provider Business Mailing Address Fax Number:
864-560-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-245-6400
Provider Business Practice Location Address Fax Number:
864-245-3838
Provider Enumeration Date:
12/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0010-07750 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4141PA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: SCH217J577 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SCH2176084 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SCH2176067 . This is a "MEDICARE PIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1508372137 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NN0844B2342423A . This is a "MEDICARE PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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