Healthcare Provider Details

I. General information

NPI: 1689694481
Provider Name (Legal Business Name): WNC SPINE SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 LEROY GEORGE DR SUITE M
CLYDE NC
28721-7430
US

IV. Provider business mailing address

262 LEROY GEORGE DR SUITE M
CLYDE NC
28721-7430
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-8378
  • Fax: 828-452-8326
Mailing address:
  • Phone: 828-452-8378
  • Fax: 828-452-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200600993
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number200200143
License Number StateNC

VIII. Authorized Official

Name: MRS. LORI C PATTERSON
Title or Position: BILLING MANAGER
Credential:
Phone: 828-452-8346