Basic Information
| Provider Information | |||||||||
| NPI: | 1467435040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WNC INTERNAL MEDICINE, PLLC | ||||||||
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| OtherOrganizationName: | WNC INTERNAL MEDICINE, PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98 COPE CREEK RD STE A-B | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287799508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285867798 | ||||||||
| FaxNumber: | 8662820679 | ||||||||
| Practice Location | |||||||||
| Address1: | 98 COPE CREEK RD STE A-B | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287799508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285867798 | ||||||||
| FaxNumber: | 8662820679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | QUEEN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8285867796 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 00220 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2084P0800X | 200500976 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207R00000X | 20370 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 011T8 | 01 | NC | BCBS PROVIDER NUMBER | OTHER | 89011T8 | 05 | NC | MEDICAID |