MEDICARE: DR. DAVID SPIVEY 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	208VP0000X	Pain Medicine Physician	30582	NC
2	208VP0014X	Interventional Pain Medicine Physician	30582	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DP0069	OTHER		RR MEDICARE - GROUP PTAN
4	P00722602	OTHER		RR MEDICARE - PROVIDER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139JW	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7695691	OTHER		AETNA

General Provider Information

NPI Number	:	1275510570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SPIVEY MD

Provider Business Mailing Address
First Line	:	2912 MAPLEWOOD AVE
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-1507
Country	:	US
Telephone Number	:	336-760-0706
Fax Number	:	336-760-1927

Provider Business Practice Location Address
First Line	:	2912 MAPLEWOOD AVE
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-1507
Country	:	US
Telephone Number	:	336-760-0706
Fax Number	:	336-760-1927

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	06/10/2014

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Directions to “ DR. DAVID SPIVEY MD” Practice Location

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