INDIAN TRAIL MEDICAL CLINIC, INC. (NPI# 1790823672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790823672 |
| Entity Type | Organization |
| Organization Name | INDIAN TRAIL MEDICAL CLINIC, INC. |
| Practice Address |
301 S. Indian Trail Road Indian Trail NC 28079 |
| Mailing Address |
Po Box 430 Indian Trail NC 28079-0430 |
| Practice Telephone | 7048217056 |
| Practice Fax Number | 7048217057 |
| Mailing Telephone | 7048217056 |
| Mailing Fax Number | 7048217057 |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2010-01-28 |
| Authorized Official Name | DR. GEORGE S.C. TSAI (MEDICAL DOCTOR) |
| Authorized Official Telephone | 7048217056 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 22284 | NC | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8901856 | 05 | |
| NC | BCBS PROVIDER NUMBER | 01856 | 01 |
| Street Address |
301 S. INDIAN TRAIL ROAD |
| City | INDIAN TRAIL |
| State | NC |
| Zip Code | 28079 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992297485 | Carolina Cala | Community/Behavioral Health | 3817 Balsam St, Indian Trail, NC 28079 | 2018-05-31 |
| 1992294805 | Dr Patel & Associates, Pa | Clinic/Center | 6046 W Highway 74, Indian Trail, NC 28079 | 2018-05-07 |
| 1306389085 | Creative Counseling and Consulting, LLC | Counselor | 4389 Indian Trail-fairview Road, Indian Trail, NC 28079 | 2016-11-29 |
| 1922481381 | Aakar Gaurang Chokshi | Dentist | 5850 W Highway 74 Ste 135, Indian Trail, NC 28079 | 2015-07-02 |
| 1881944536 | Francy Johana Rodriguez | Naturopath | 124 Unionville Indian Trail Rd W Ste A9, Indian Trail, NC 28079 | 2012-09-10 |
| 1669767653 | Leigh Ann Zimmerman Tasillo | Psychologist | 124 Unionville-indian Trail Rd., Suite B3, Indian Trail, NC 28079 | 2011-06-17 |
| 1679715650 | Indian Trail Chiropractic & Rehabilitation, Pa | Chiropractor | 100 Park Road East, Indian Trail, NC 28079 | 2009-04-06 |
| 1003079518 | Shemeeka L Mcfadden | Optometrist | 5850 Us-74, Unit 116, Indian Trail, NC 28079 | 2008-07-03 |
| 1023290046 | Gary Lee Vaughn | Technician/Technologist | 622 Indian Trail Rd, Indian Trail, NC 28079 | 2007-11-30 |
| 1750574331 | Susana C Junco | Dentist | 136 Indian Trail Rd, Indian Trail, NC 28079 | 2007-08-27 |
| Find all providers in zip 28079 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619188620 | Charlotte Cardiology Associates, P.a | Specialist | 5850 W Highway 74, Ste 500, Indian Trail, NC 28079-3400 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989812 | Ryan Graham | Specialist | 405 Avett Dr, Durham, NC 27703-8291 | 2020-07-14 |
| 1184248197 | Tunishia Chanel Parks | Specialist | 106 Daniels Ave, Battleboro, NC 27809-7503 | 2020-06-05 |
| 1306460811 | Ashley Davis | Specialist | 765 Highland Oaks Dr Ste 100, Winston Salem, NC 27103-7100 | 2020-06-01 |
| 1083236996 | Latisha Isheema Buchanan | Specialist | 3215 Guess Rd Ste 101, Durham, NC 27705-2668 | 2020-05-13 |
| 1356962872 | Katherine Joy Griffin | Specialist | 1112 Bottle Brush Ln, Harrisburg, NC 28075-6716 | 2020-05-06 |
| 1174158315 | Shanese Spaulding | Specialist | 309 N Elm St, Lumberton, NC 28358-5649 | 2020-03-09 |
| 1417590290 | Sarah Lyn Granahan | Specialist | 107 Windel Dr Ste 205, Raleigh, NC 27609-4471 | 2019-10-23 |
| 1215580949 | Felisha Cheadle | Specialist | 240 Appalachian Dr, Raeford, NC 28376-6342 | 2019-07-22 |
| 1962062240 | Shenika Twanet Judd | Specialist | 724 N Reilly Rd Ste C, Fayetteville, NC 28303-6042 | 2019-06-18 |
| 1033676358 | Suzanne Lynn Washburn | Specialist | 307 Barcelona Drive 26e, Fayetteville, NC 28303-5768 | 2019-02-22 |
| Find all providers with the same taxonomy | ||||
| City | INDIAN TRAIL |
| Zip Code | 28079 |
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| 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.