WILLIE ROSCOE WHITAKER (NPI# 1861489759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861489759 |
| Entity Type | Individual |
| Full Name | WILLIE ROSCOE WHITAKER |
| Credential | M.D. |
| Practice Address |
2117 Simonton Rd Suite 102 Statesville NC 28625-8403 |
| Practice Telephone | 7048728422 |
| Practice Fax Number | 7048728705 |
| Mailing Telephone | 7048728422 |
| Mailing Fax Number | 7048728705 |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2014-03-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | NC2003-00428 | NC | Allopathic & Osteopathic Physicians |
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
2003-00428 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89134J6 | 05 | |
| NC | BLUE CROSS BLUE SHIELD # | 134J6 | 01 |
| NC | PARTNERS' MEDICARE # | 38354 | 01 |
| NC | RAILROAD MEDICARE | P00010140 | 01 |
| NC | MEDCOST | C8620 | 01 |
| NC | CIGNA HEALTHCARE PROVIDER | 3324386 | 01 |
| UPIN | E73961 | 01 |
| Street Address |
2117 SIMONTON RD SUITE 102 |
| City | STATESVILLE |
| State | NC |
| Zip Code | 28625-8403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972882140 | Perry S Justice Jr Dds Pa | Dentist | 2117 Simonton Rd, Suite 403, Statesville, NC 28625-8206 | 2011-08-05 |
| 1851421515 | Perry Stephen Justice Jr. | Dentist | 2117 Simonton Rd, Suite 403, Statesville, NC 28625-8403 | 2007-03-06 |
| 1023125861 | Michael Borja | Specialist | 2117 Simonton Rd, Suite 402, Statesville, NC 28625-8206 | 2006-08-25 |
| 1083729701 | Northlake Pediatric Care Pa | Pediatrics | 2117 Simonton Rd, Suite 402, Statesville, NC 28625-8206 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714163 | Sandra Lourdes Mayta | Counselor | 1450 Fern Creek Drive, Statesville, NC 28625 | 2020-03-05 |
| 1023643582 | Youngchi Chang Dds Pllc | Dentist | 964 Glenway Ave Ste A, Statesville, NC 28625 | 2020-03-05 |
| 1538799200 | Nicole-marie Blischak | Dentist | 964 Glenway Dr, Ste A, Statesville, NC 28625 | 2020-01-22 |
| 1013575257 | Sherry Neilson | Registered Nurse | 524 Signal Hill Rd, Statesville, NC 28625 | 2019-06-03 |
| 1770904328 | Elinor Kyle Tyner | Counselor | 1206 Museum Road, Statesville, NC 28625 | 2013-12-30 |
| 1982031001 | Tamiko Bradley | Counselor | 524 Signal Hill Dr Ext, Statesville, NC 28625 | 2013-10-03 |
| 1487932505 | Nicole Weisner Winecoff | Advanced Practice Midwife | 1420 Fern Creek Drive, Statesville, NC 28625 | 2011-07-22 |
| 1538461967 | Bethany J Sprague | Nurse Practitioner | 2632 Fines Creek Dr, Statesville, NC 28625 | 2010-11-17 |
| 1477789147 | Greenbriar Primary Care, Pa | Nurse Practitioner | 308-c Mocksville Highway, Statesville, NC 28625 | 2009-06-08 |
| 1619122538 | Phasebdevelopment | Substance Abuse Rehabilitation Facility | 113 Bethany Rd, Statesville, NC 28625 | 2008-11-19 |
| Find all providers in zip 28625 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174548028 | Northlake Nephrology Pllc | Internal Medicine | 1665 Davie Ave, Statesville, NC 28677-3519 | 2006-07-13 |
| 1730150459 | Jean-claude Hyppolite | Internal Medicine | 2603 Davie Ave, Statesville, NC 28625-8256 | 2006-01-30 |
| 1225059017 | Wolfgang Erich Lohrmann | Internal Medicine | 2603 Davie Ave, Statesville, NC 28625-8256 | 2006-07-21 |
| 1295780781 | Kidney Care, P.C. | Internal Medicine | 2603 Davie Ave, Statesville, NC 28625-8256 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982251492 | Renal Care, Pllc | Internal Medicine | 607 E Parker Rd Ste A, Morganton, NC 28655-8105 | 2019-08-20 |
| 1508360462 | North Carolina Nephrology Pa | Internal Medicine | 3604 Bush St Fl 2, Raleigh, NC 27609-7511 | 2018-03-23 |
| 1558865444 | North Carolina Nephrology Pa | Internal Medicine | 1006 N Arendell Ave, Zebulon, NC 27597-2352 | 2018-03-23 |
| 1932603800 | North Carolina Nephrology Pa | Internal Medicine | 2824 Rogers Rd Ste 104, Wake Forest, NC 27587-3896 | 2018-03-23 |
| 1760986608 | North Carolina Nephrology Pa | Internal Medicine | 160 Macgregor Pines Dr Ste 301, Cary, NC 27511-6037 | 2018-03-23 |
| 1083168181 | Private Diagnostic Clinic, Pllc | Internal Medicine | 10207 Cerny St Ste 306, Raleigh, NC 27617-4879 | 2016-08-08 |
| 1932596525 | Robert Lorch | Internal Medicine | 2 Genome Ct, Durham, NC 27710-3011 | 2015-04-21 |
| 1770991945 | Barbara Gillespie | Internal Medicine | 109 Linton Banks Pl, Cary, NC 27513-2051 | 2014-07-31 |
| 1902216757 | Evan Zeitler | Internal Medicine | 102 Mason Farm Road, Cb 7020, Chapel Hill, NC 27599-7020 | 2014-05-02 |
| 1649512583 | William Preston Nixon Jr. | Internal Medicine | 2 Jasmine Ct, Wrightsville Beach, NC 28480-1924 | 2013-03-18 |
| Find all providers with the same taxonomy | ||||
| City | STATESVILLE |
| Zip Code | 28625 |
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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.