MEDICARE: ESPIRITU CLINIC PLLC

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

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

General Provider Information

NPI Number	:	1497722359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESPIRITU CLINIC PLLC

Provider Business Mailing Address
First Line	:	2425 N CENTER ST
Second Line	:	370
City	:	HICKORY
State	:	NC
Zip	:	28601-1320
Country	:	US
Telephone Number	:	888-898-7130
Fax Number	:	828-322-7921

Provider Business Practice Location Address
First Line	:	715 FAIRGROVE CHURCH RD SE
Second Line	:	SUITE 204
City	:	CONOVER
State	:	NC
Zip	:	28613-9290
Country	:	US
Telephone Number	:	888-898-7130
Fax Number	:	828-322-7921

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. HERNANE BAUTISTA ESPIRITU
Credential	:
Telephone Number	:	888-898-7130

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	01/21/2011

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