=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851341937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRIS A. PATE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2280 US HIGHWAY 70 W
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27530-9546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-735-1400
-----------------------------------------------------
Fax | 919-581-0353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2831
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27715-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-544-6318
-----------------------------------------------------
Fax | 919-544-6336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | TRENT O SHELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-544-6318
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 32555
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------