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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.

NPI Number 1790823672
LBN Legal business name INDIAN TRAIL MEDICAL CLINIC, INC.
Authorized official GEORGE TSAI - (MEDICAL DOCTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 02/02/2007
Last updated 01/28/2010 - About 16 years ago
Identifiers
NC License # 22284
NC Medicaid 8901856
NC Other 01856 BCBS PROVIDER NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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