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3330 Siskey Pkwy Matthews NC 28105-3222 | |
| (704) 316-9001 | |
| (704) 316-9008 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3330 Siskey Pkwy, Matthews, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (EDI MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: (704) 316-9001 | 3330 Siskey Pkwy Matthews NC 28105-3222 Ph: (704) 316-9001 |
| NPI Number | 1083666887 |
|---|---|
| Provider Enumeration Date | 05/17/2006 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083666887 | NPI | - | NPPES |
| 017YG | Other | NC | BCBS NC |
| CC5118 | Other | NC | RAILROAD MEDICARE |
| NPB172 | Medicaid | SC | |
| 5903547 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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