DR. LISA ELLEN PACK (NPI# 1346405867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346405867 |
| Entity Type | Individual |
| Full Name | DR. LISA ELLEN PACK |
| Credential | MD |
| Practice Address |
3186 Village Dr Ste 201 Fayetteville NC 28304-3979 |
| Practice Telephone | 9104865700 |
| Practice Fax Number | 9104865950 |
| Mailing Telephone | 9104865700 |
| Mailing Fax Number | 9104865950 |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2017-03-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD445513 | PA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346670643 | Lisa Pack | Physical Therapy Assistant | 1600 Saint Paris Pike, Springfield, OH 45504-1226 | 2013-11-22 |
| Street Address |
3186 VILLAGE DR STE 201 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-3979 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326041955 | George A. Binder | Radiology | 3186 Village Dr, Suite 201, Fayetteville, NC 28304-3978 | 2005-05-27 |
| 1740799378 | Larra Ashley Hunt | Nurse Practitioner | 3186 Village Dr, Fayetteville, NC 28304-3978 | 2017-09-27 |
| 1205154465 | Walson Kehinde Metzger | Radiology | 3186 Village Dr, Suite 201, Fayetteville, NC 28304-3978 | 2010-05-12 |
| 1851615405 | Grant Yanagi | Radiology | 3186 Village Dr, Ste 201, Fayetteville, NC 28304-3979 | 2010-03-24 |
| 1245474022 | Medical Imaging Center, LLC | Physiological Laboratory | 3186 Village Dr, Suite 101, Fayetteville, NC 28304-3978 | 2009-04-24 |
| 1912075631 | Kirk Shane Russell | Radiology | 3186 Village Dr, Suite 201, Fayetteville, NC 28304-3978 | 2006-12-01 |
| 1730107798 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 3186 Village Dr, Ste 202, Fayetteville, NC 28304-3865 | 2006-07-18 |
| 1770532269 | Fayetteville Open Mri, LLC | Physiological Laboratory | 3186 Village Dr, Fayetteville, NC 28304-3865 | 2006-05-10 |
| 1073561478 | National Imaging Affiliates of Fayetteville, Inc | Physiological Laboratory | 3186 Village Dr, Fayetteville, NC 28304-3865 | 2006-05-05 |
| 1316948094 | Lisa Hutchison | Physician Assistant | 3186 Village Dr, Suite 201, Fayetteville, NC 28304-3978 | 2005-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700211653 | Medical Associates of Northwest Arkansas Pa | Radiology | 3383 N Mana Ct Ste 102, Fayetteville, AR 72703-4965 | 2013-09-11 |
| 1831534346 | Kevin Tyler Goelz | Radiology | 605 Wentworth Ct, Fayetteville, GA 30215 | 2013-05-10 |
| 1689859829 | Santiago Miro | Radiology | 7302 Wakefield Dr, Fayetteville, NY 13066-9755 | 2008-01-07 |
| 1295858967 | Garney H Fendley | Radiology | 3215 N. North Hills Blvd, Fayetteville, AR 72703-4424 | 2007-04-09 |
| 1558424986 | Joseph Vincent Scrivani | Radiology | 5436 Springview Dr, Fayetteville, NY 13066-9678 | 2006-12-18 |
| 1538244751 | Bernard Schneider | Radiology | 7064 Woodchuck Hill Rd, Fayetteville, NY 13066-9764 | 2006-10-26 |
| 1023190097 | Andrew Bostaph | Radiology | 3027 Hampton Ridge Rd, Fayetteville, NC 28311-3005 | 2006-10-19 |
| 1326095639 | Cynthia Evette P Humphries | Radiology | 2053 Loganberry Dr, Fayetteville, NC 28304-0804 | 2006-05-30 |
| 1134170160 | Medical Associates of Northwest Arkansas Pa | Radiology | 55 W Sunbridge Dr, Fayetteville, AR 72703-1825 | 2006-05-15 |
| 1669430971 | Carolina Imaging LLC of Fayetteville | Radiology | 3628 Cape Center Dr, Fayetteville, NC 28304-4406 | 2006-05-03 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
Please comment or provide details below to improve the information on DR. LISA ELLEN PACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.