Basic Information
| Provider Information | |||||||||
| NPI: | 1588614176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNSEE | ||||||||
| FirstName: | ROCK | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 S HERLONG AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297323399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033281864 | ||||||||
| FaxNumber: | 8033281865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-01599 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 1386 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0953PA | 05 | SC | MEDICAID | 1951786 | 01 | NC | COVENTRY | OTHER | P01044561 | 01 | NC | RAILROAD MEDICARE PTAN | OTHER | 20083727 | 01 | SC | SELECT HEALTH OF SC | OTHER | 8102538 | 05 | NC | MEDICAID | P01084938 | 01 | SC | MEDICARE RAILROAD | OTHER | 164XC | 01 | NC | BCBSNC | OTHER |