MEDICARE: DR. BILLIE CANDICE PACK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	OS012220	PA
2	208100000X	Physical Medicine & Rehabilitation Physician	N2226	TX
3	208100000X	Physical Medicine & Rehabilitation Physician	2011-01899	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	613851	OTHER	TX	MEDICARE PTAN
3	NC47140281	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487629739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILLIE CANDICE PACK D.O.

Provider Business Mailing Address
First Line	:	9 CRESTMONT CT.
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-9480
Country	:	US
Telephone Number	:	412-657-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	4230 N ROXBORO ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-1826
Country	:	US
Telephone Number	:	919-477-9805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	03/05/2012

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Directions to “ DR. BILLIE CANDICE PACK D.O.” Practice Location

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