MEDICARE: DR. NANCY ELLEN CLINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	20157	SC
2	207W00000X	Ophthalmology Physician	98 01213	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11512	OTHER	NC	BCBS
2	2257439	OTHER		MC SOUTH CAROLINA
3	561705541	OTHER		CMS 1500
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	561705541	OTHER		HEALTHSOURCE SC INC
6	561705541	OTHER		AETNA
7	11512	OTHER		BLUE CROSS BLUE SHIELD
8	0841483	OTHER		UNITED HEALTH CARE
9	2075830	OTHER		FIRST HEALTH
10	2109354	OTHER		MAMSI INSURANCE
11	11512	OTHER	SC	BCBS
12	561705541	OTHER	NC	WORKMANS COMP
13	561705541	OTHER	SC	WORKMANS COMP

General Provider Information

NPI Number	:	1093791352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ELLEN CLINE MD

Provider Business Mailing Address
First Line	:	1170 WYKE RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4259
Country	:	US
Telephone Number	:	704-482-6767
Fax Number	:	704-600-6232

Provider Business Practice Location Address
First Line	:	1170 WYKE RD.
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3406
Country	:	US
Telephone Number	:	704-482-6767
Fax Number	:	704-484-2507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	10/05/2023

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