MEDICARE: LAWRENCE FRANCIS SUPIK MD

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	207X00000X	Orthopaedic Surgery Physician	200101615	NC

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	:	1912900523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE FRANCIS SUPIK MD

Provider Business Mailing Address
First Line	:	80 HEALTHCARE DR
Second Line	:	STE 203
City	:	SYLVA
State	:	NC
Zip	:	28779-5126
Country	:	US
Telephone Number	:	828-586-5531
Fax Number	:	828-586-5759

Provider Business Practice Location Address
First Line	:	80 HEALTHCARE DR
Second Line	:	STE 203
City	:	SYLVA
State	:	NC
Zip	:	28779-5146
Country	:	US
Telephone Number	:	828-586-5531
Fax Number	:	828-586-5759

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/05/2012

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