MEDICARE: ROCKY MOUNT NEUROSURGICAL AND SPINE CONSULTANTS, 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		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417910480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNT NEUROSURGICAL AND SPINE CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	PO BOX 7546
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-0546
Country	:	US
Telephone Number	:	252-443-4563
Fax Number	:	252-443-6461

Provider Business Practice Location Address
First Line	:	2412 PROFESSIONAL DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2253
Country	:	US
Telephone Number	:	252-443-4563
Fax Number	:	252-443-6461

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DEBORAH M DEW
Credential	:
Telephone Number	:	252-443-4563

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/22/2020

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