NPIMap

Organization Active NPI

Indian Trail Medical Clinic, Inc.

  • Specialist
  • Indian Trail, NC
National Provider Identifier
1790823672
Registry record updated Jan 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
22284 Issued in NC
Legal business name
INDIAN TRAIL MEDICAL CLINIC, INC.
Practice address
301 S. Indian Trail Road
Indian Trail, NC 28079
Phone
(704) 821-7056
Fax
(704) 821-7057
NPI assigned
Feb 2, 2007
Last updated
Jan 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. George S.C. Tsai, M.D.NPI 1518047539
Title
Medical Doctor
Phone
(704) 821-7056

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 22284 NC Primary

Addresses

Primary practice location

301 S. Indian Trail Road
Indian Trail, NC 28079

Mailing address

PO Box 430
Indian Trail, NC 28079-0430
Phone (704) 821-7056

Other identifiers 2

IdentifierTypeStateIssuer
8901856MedicaidNC
01856OtherNCBCBS PROVIDER NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264636800000",
    "number": "1790823672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280790430",
            "telephone_number": "704-821-7056",
            "fax_number": "704-821-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S. INDIAN TRAIL ROAD",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "28079",
            "telephone_number": "704-821-7056",
            "fax_number": "704-821-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TRAIL MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2010-01-28",
        "status": "A",
        "authorized_official_last_name": "TSAI",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "S.C.",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "704-821-7056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "22284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901856",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "01856",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Trail, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.