Healthcare Provider Details

I. General information

NPI: 1447753777
Provider Name (Legal Business Name): PYB, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SE CARY PKWY STE 201
CARY NC
27518-7420
US

IV. Provider business mailing address

1110 SE CARY PKWY STE 201
CARY NC
27518-7420
US

V. Phone/Fax

Practice location:
  • Phone: 919-239-4711
  • Fax:
Mailing address:
  • Phone: 919-239-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2014-00886
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2014-00886
License Number StateNC

VIII. Authorized Official

Name: DR. WILLIAM A VAN HORN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 919-239-4711