Healthcare Provider Details

I. General information

NPI: 1629261565
Provider Name (Legal Business Name): INTERVENTIONAL PAIN SERVICES OF WESTERN NORTH CAROLINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FALCON CREST LN
CLYDE NC
28721-6620
US

IV. Provider business mailing address

24 FALCON CREST LN
CLYDE NC
28721-6620
US

V. Phone/Fax

Practice location:
  • Phone: 828-627-9998
  • Fax: 828-627-9946
Mailing address:
  • Phone: 828-627-9998
  • Fax: 828-627-9946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number30531
License Number StateNC

VIII. Authorized Official

Name: DR. ALLAN NORMAN ZACHER III
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 828-627-9998