Organization
INDIAN TRAIL MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE S.C. TSAI M.D. (MEDICAL DOCTOR)
(704) 821-7056
Entity
Organization
Contact information
Practice address
301 S. INDIAN TRAIL ROAD, INDIAN TRAIL, NC 28079
(704) 821-7056
(704) 821-7057
Mailing address
PO BOX 430, INDIAN TRAIL, NC 28079-0430
(704) 821-7056
(704) 821-7057
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22284
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01856
BCBS PROVIDER NUMBER
NC
05
—
8901856
—
NC
Enumeration date
02/02/2007
Last updated
01/28/2010
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