Basic Information
| Provider Information | |||||||||
| NPI: | 1861712234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TATE CLINIC, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843 | ||||||||
| Address2: | |||||||||
| City: | LINVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286460843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287377917 | ||||||||
| FaxNumber: | 8287376869 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287654201 | ||||||||
| FaxNumber: | 8287376869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 06/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | TATE, II | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8287377917 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | GROUP#02822 | 01 | NC | BCBS | OTHER | GROUP#8902822 | 05 | NC | MEDICAID |