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NPI Code Detail

MEDICARE: MR. DALE LEE GILREATH C.S.A

MEDICARE: MR. DALE LEE GILREATH C.S.A
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
1246ZS0410XSurgical Technologist2628NC

General Provider Information

NPI Number : 1861473860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DALE LEE GILREATH C.S.A
Provider Business Mailing Address
First Line : 1318 KEYSTONE DR
Second Line :
City : SALISBURY
State : NC
Zip : 28147-7926
Country : US
Telephone Number : 704-212-2266
Fax Number :
Provider Business Practice Location Address
First Line : 612 MOCKSVILLE AVE
Second Line :
City : SALISBURY
State : NC
Zip : 28144-2732
Country : US
Telephone Number : 704-210-5084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 07/08/2007

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