=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073768461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN SURGICAL CENTER, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2008
-----------------------------------------------------
Last Update Date | 11/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 LIVINGSTON ST SUITE 300
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-258-2464
-----------------------------------------------------
Fax | 828-255-8224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 LIVINGSTON ST SUITE 300
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-258-2464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT C MOFFATT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 828-258-2464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086X0206X
-----------------------------------------------------
Taxonomy Name | Surgical Oncology Physician
-----------------------------------------------------
License Number | 14543
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------