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General NPI Number Information
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NPI Number | 1811253065
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNT PAIN AND SPINE
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 7780 BRIER CREEK PKWY 200
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City | RALEIGH
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State | NC
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Zip | 27617-7849
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Country | US
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Telephone | 919-596-3400
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Fax | 919-596-3499
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Provider Business Mailing Address
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Address Line | 121 ENTERPRISE DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-9516
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Country | US
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Telephone | 252-200-5180
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Fax | 252-200-5186
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Authorized Official
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Title or Position | ADMINISTRATIVE COORDINATOR
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Name | NICOLE CARLSON
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Credential |
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Telephone | 252-200-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 141911
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License Number State | NC
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