Provider Demographics
NPI:1538270731
Name:CAROLINA SPINE & HAND CENTER PA
Entity type:Organization
Organization Name:CAROLINA SPINE & HAND CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-636-4646
Mailing Address - Street 1:1809 BRENNER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144
Mailing Address - Country:US
Mailing Address - Phone:704-636-4646
Mailing Address - Fax:704-636-4447
Practice Address - Street 1:1809 BRENNER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-636-4646
Practice Address - Fax:704-636-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103906363A00000X
NC101229363A00000X
NC9900416207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891226WMedicaid
NCG89487Medicare UPIN
NC2330323Medicare PIN
NC4623200001Medicare NSC