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Contact Information

INDIAN TRAIL MEDICAL CLINIC, INC.
301 S. INDIAN TRAIL ROAD
INDIAN TRAIL, NC28079
 Phone: 704-821-7056
 Fax: 704-821-7057
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for INDIAN TRAIL MEDICAL CLINIC INC · (Female)

NPI # 1790823672
Status Active
Credentials
Entity Individual
Enumeration date 02/02/2007
Last updated 01/28/2010 - About 16 years ago
Sole proprietor 1 Not specified
Identifiers
  • NC License # 22284
  • NC Medicaid 8901856
  • NC Other 01856 BCBS PROVIDER NUMBER
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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