Healthcare Provider Details

I. General information

NPI: 1891074241
Provider Name (Legal Business Name): CHAD ALLAN YORK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 11/21/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PALMER JERVEY DR STE B
COLUMBUS NC
28722-8516
US

IV. Provider business mailing address

52 HOSPITAL DR STE 3A
COLUMBUS NC
28722-8516
US

V. Phone/Fax

Practice location:
  • Phone: 828-894-2390
  • Fax: 828-894-2390
Mailing address:
  • Phone: 828-894-2473
  • Fax: 828-894-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001011830
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001011830
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number305759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: