Healthcare Provider Details

I. General information

NPI: 1578803177
Provider Name (Legal Business Name): BILTMORE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 INDIAN TRAIL RD S SUITE 250
INDIAN TRAIL NC
28079-8689
US

IV. Provider business mailing address

598 INDIAN TRAIL RD S SUITE 250
INDIAN TRAIL NC
28079-8689
US

V. Phone/Fax

Practice location:
  • Phone: 704-719-9722
  • Fax: 704-719-9732
Mailing address:
  • Phone: 704-719-9722
  • Fax: 704-719-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34123
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200001111
License Number StateNC

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 704-719-9722