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NPI Code Detail

MEDICARE: DR. BILLY JACK PENCE MD

MEDICARE: DR. BILLY JACK PENCE 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
1207R00000XInternal Medicine Physician201001079NC
2208M00000XHospitalist Physician201001079NC

General Provider Information

NPI Number : 1588647390
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BILLY JACK PENCE MD
Provider Business Mailing Address
First Line : PO BOX 602373
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2373
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 119 MOUNTAIN VIEW RD
Second Line :
City : MARS HILL
State : NC
Zip : 28754-9500
Country : US
Telephone Number : 828-689-3507
Fax Number : 828-649-3505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2005
Last Update Date : 01/10/2024

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