Basic Information
| Provider Information | |||||||||
| NPI: | 1669444527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAHN | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 DOCTORS ST | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363725606 | ||||||||
| FaxNumber: | 3363726211 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 DOCTORS ST | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286759247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363725606 | ||||||||
| FaxNumber: | 3363726211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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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 | 207Q00000X | 19788 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 21734 | 01 | MEDCOST | OTHER | 5001 | 01 | PARTNERS CHOICE | OTHER | 5603595 | 05 | VA | MEDICAID | 20644 | 01 | NCBCBS | OTHER | 8920644 | 05 | NC | MEDICAID | 0107814 | 01 | UNITIED HEALTHCARE | OTHER |