Basic Information
| Provider Information | |||||||||
| NPI: | 1649228545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALISBURY OB GYN. PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 MOCKSVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281443323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046459200 | ||||||||
| FaxNumber: | 7046379815 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 MOCKSVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281443323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046459200 | ||||||||
| FaxNumber: | 7046379815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 11/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | MILLS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7046459200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 89014VT | 05 | NC | MEDICAID |