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501 Billingsley Rd Ste B Charlotte NC 28211-1009 | |
| (704) 444-2400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 501 Billingsley Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Scott Rissmiller (ENTERPRISE EVP) |
| Authorized Official Contact | 7043558675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 19305 Charlotte NC 28219-9305 Ph: (704) 631-0002 | 501 Billingsley Rd Ste B Charlotte NC 28211-1009 Ph: (704) 444-2400 |
| NPI Number | 1356689996 |
|---|---|
| Provider Enumeration Date | 01/16/2013 |
| Last Update Date | 03/09/2023 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 4789597477 |
|---|---|
| Medicare Enrollment ID | O20230803001286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356689996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Shane M Tussey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871938126 PECOS PAC ID: 1658667365 Enrollment ID: I20230803001125 |
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