MEDICARE: MR. RICHARD WILLIAM POOLE PA-C

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	363AM0700X	Medical Physician Assistant	0010-10300	NC

General Provider Information

NPI Number	:	1548462161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD WILLIAM POOLE PA-C

Provider Business Mailing Address
First Line	:	118 GAYMONT CIR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-8320
Country	:	US
Telephone Number	:	704-873-1855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 US HIGHWAY 70 SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-5164
Country	:	US
Telephone Number	:	828-270-7331
Fax Number	:	828-322-3280

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/13/2020

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