| Select Health Pain And Regenerative Medicine Pc | |
|
15720 Brixham Hill Ave Ste 130 Charlotte NC 28277-4784 | |
| (704) 541-5555 | |
| Not Available |
| Full Name | Select Health Pain And Regenerative Medicine Pc |
|---|---|
| Speciality | General Practice |
| Location | 15720 Brixham Hill Ave Ste 130, Charlotte, North Carolina |
| Authorized Official Name and Position | Eric Shapiro (PRESIDENT) |
| Authorized Official Contact | 7047632151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Select Health Pain And Regenerative Medicine Pc 15720 Brixham Hill Ave Ste 130 Charlotte NC 28277-4784 Ph: (704) 541-5555 | Select Health Pain And Regenerative Medicine Pc 15720 Brixham Hill Ave Ste 130 Charlotte NC 28277-4784 Ph: (704) 541-5555 |
| NPI Number | 1124636667 |
|---|---|
| Provider Enumeration Date | 07/21/2020 |
| Last Update Date | 07/21/2020 |
| Medicare PECOS PAC ID | 0143648477 |
|---|---|
| Medicare Enrollment ID | O20200917001941 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124636667 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Joe Douglas Haines |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275504938 PECOS PAC ID: 0143480392 Enrollment ID: I20120326000168 |
| Provider Name | Katherine S Shue-mcguffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174994883 PECOS PAC ID: 6305148693 Enrollment ID: I20160104001159 |
| Provider Name | Jessica R Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730797978 PECOS PAC ID: 6406274745 Enrollment ID: I20200917002507 |
| Provider Name | Stacey C Bohm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508484031 PECOS PAC ID: 6507284684 Enrollment ID: I20200922002614 |
| Provider Name | Danielle Marie Crum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457941007 PECOS PAC ID: 5294149217 Enrollment ID: I20210202001571 |
| Provider Name | Rachel Olivia Taylor Mcleod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770195216 PECOS PAC ID: 5890100648 Enrollment ID: I20210209001834 |
| Provider Name | Amanda L Mattox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831768159 PECOS PAC ID: 1658776208 Enrollment ID: I20210820000893 |
| Provider Name | Chevon Pegues |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760850382 PECOS PAC ID: 1153751227 Enrollment ID: I20211214001195 |
| Provider Name | Zena M Al-abed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528727336 PECOS PAC ID: 9638562507 Enrollment ID: I20220217001374 |
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