Provider Demographics
NPI:1366437915
Name:METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA
Entity type:Organization
Organization Name:METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-864-6500
Mailing Address - Street 1:PO BOX 550490
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28055-0490
Mailing Address - Country:US
Mailing Address - Phone:704-864-6500
Mailing Address - Fax:704-864-0104
Practice Address - Street 1:825 MAJESTIC CT STE F
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5190
Practice Address - Country:US
Practice Address - Phone:704-864-6500
Practice Address - Fax:704-864-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16674OtherPARTNERS MEDICARE
NC1036MOtherBLUE CROSS
NC5900575Medicaid
NC7152565OtherCIGNA
SCNPA752OtherSC MEDICAID
NC5900575Medicaid
NC2346162Medicare PIN