Provider Demographics
NPI:1871551911
Name:METROLINA SURGICAL SPECIALISTS, PLLC
Entity type:Organization
Organization Name:METROLINA SURGICAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:NNAEMKA
Authorized Official - Last Name:ERUCHALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-375-0404
Mailing Address - Street 1:PO BOX 49092
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0073
Mailing Address - Country:US
Mailing Address - Phone:704-375-0404
Mailing Address - Fax:704-375-0705
Practice Address - Street 1:485 N WENDOVER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1064
Practice Address - Country:US
Practice Address - Phone:704-375-0404
Practice Address - Fax:704-375-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1036LOtherBLUE CROSS BLUE SHIELD
NC8930776Medicaid
NC10039OtherPARTNERS MEDICARE
NC10039OtherPARTNERS MEDICARE
NC1036LOtherBLUE CROSS BLUE SHIELD