Basic Information
Provider Information | |||||||||
NPI: | 1346837739 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNC PHYSICIANS GROUP PRACTICES II, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | UNC HEALTH RALEIGH ORTHOPEDIC CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2000 PERIMETER PARK DR STE 200 | ||||||||
Address2: |   | ||||||||
City: | MORRISVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 275608442 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197815600 | ||||||||
FaxNumber: | 9198594281 | ||||||||
Practice Location | |||||||||
Address1: | 781 AVENT FERRY RD STE 110 | ||||||||
Address2: |   | ||||||||
City: | HOLLY SPRINGS | ||||||||
State: | NC | ||||||||
PostalCode: | 275407776 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197815600 | ||||||||
FaxNumber: | 9198594281 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/31/2020 | ||||||||
LastUpdateDate: | 02/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FISCUS | ||||||||
AuthorizedOfficialFirstName: | LYNNE | ||||||||
AuthorizedOfficialMiddleName: | CHRISTINE | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 9842154111 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 207X00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.