Basic Information
| Provider Information | |||||||||
| NPI: | 1649214289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRESBYTERIAN REGIONAL HEALTHCARE CORPORATION | ||||||||
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| OtherOrganizationName: | PRESBYTERIAN NEUROLOGY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 RANDOLPH RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043849113 | ||||||||
| FaxNumber: | 7043160508 | ||||||||
| Practice Location | |||||||||
| Address1: | 1718 E 4TH ST | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043849437 | ||||||||
| FaxNumber: | 7043849440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EASTERLING | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7043849113 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.