MEDICARE: METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA

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	174400000X	Specialist	9600205	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16674	OTHER	NC	PARTNERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1036M	OTHER	NC	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7152565	OTHER	NC	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366437915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA

Provider Business Mailing Address
First Line	:	PO BOX 550490
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28055-0490
Country	:	US
Telephone Number	:	704-864-6500
Fax Number	:	704-864-0104

Provider Business Practice Location Address
First Line	:	825 MAJESTIC CT STE F
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-5190
Country	:	US
Telephone Number	:	704-864-6500
Fax Number	:	704-864-0104

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AUGUSTINE R EZE
Credential	:	M.D.
Telephone Number	:	704-864-6500

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/22/2012

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