Provider Demographics
NPI:1548443435
Name:WESTERN CAROLINA PHYSICIAN NETWORK
Entity type:Organization
Organization Name:WESTERN CAROLINA PHYSICIAN NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WYLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-631-7000
Mailing Address - Street 1:35 FACILITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-0279
Mailing Address - Country:US
Mailing Address - Phone:828-456-5042
Mailing Address - Fax:828-456-9814
Practice Address - Street 1:35 FACILLITY DR.
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-0279
Practice Address - Country:US
Practice Address - Phone:828-456-5042
Practice Address - Fax:828-456-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01581207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147XHOtherBCBS
NC5909076Medicaid
NC5909076Medicaid
NC2021873AMedicare PIN