Healthcare Provider Details

I. General information

NPI: 1922093434
Provider Name (Legal Business Name): NORTH CAROLINA SPINE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CONNER DR SUITE 200
CHAPEL HILL NC
27514-7038
US

IV. Provider business mailing address

101 CONNER DR SUITE 200
CHAPEL HILL NC
27514-7038
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-1629
  • Fax: 919-929-4019
Mailing address:
  • Phone: 919-942-1629
  • Fax: 919-929-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number28441
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200301142
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8262
License Number StateNC

VIII. Authorized Official

Name: MR. DAVID LEE ROBERTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-942-1629