Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QA1903X | Clinic/Center | Ambulatory Surgical | AS0037 | NORTH CAROLINA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0734076003 | OTHER | NORTH CAROLINA | CIGNA |
| 2 | 9519 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | PARTNERS MEDICARE |
| 3 | 00632 | OTHER | NORTH CAROLINA | BLUE CROSS |
| 4 | 3409852 | MEDICAID | NORTH CAROLINA | |
| 5 | 312280 | OTHER | NORTH CAROLINA | FEDERAL BLACK LUNG |
| 6 | 238024 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | CIGNA MEDICARE |
| 7 | 0585105 | OTHER | NORTH CAROLINA | AETNA |
| 8 | 371708500 | OTHER | NORTH CAROLINA | DEPARTMENT OF LABOR |
| 9 | ASC002 | MEDICAID | SOUTH CAROLINA | |
| 10 | 3697 | OTHER | NORTH CAROLINA | WELLPATH |
| 11 | 5040770 | OTHER | NORTH CAROLINA | UNITED HEALTHCARE |
| 12 | 490004182 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDICARE RAILROAD |
