Basic Information
| Provider Information | |||||||||
| NPI: | 1366830390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROWAN DIAGNOSTIC CLINIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPENCER FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 MOCKSVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281442705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046337220 | ||||||||
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| Practice Location | |||||||||
| Address1: | 446 S SALISBURY AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SPENCER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281592239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046337220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2014 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | VERHAEGHE | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7046337220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROWAN DIAGNOSTIC CLINIC, PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.