WILLIAM JOHN EDMISTON JR.


Address: 170 Medical Park Rd, Suite 301, Mooresville, NC 28117-8540
Phone: 7043604378

WILLIAM JOHN EDMISTON JR. (NPI# 1053420190) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053420190
Entity Type Individual
Full Name WILLIAM JOHN EDMISTON JR.
Credential MD
Practice Address 170 Medical Park Rd
Suite 301
Mooresville
NC 28117-8540
Practice Telephone 7043604378
Practice Fax Number 7046968150
Mailing Telephone 7043604378
Mailing Fax Number 7046968150
Enumeration Date 2006-08-30
Last Update Date 2013-06-18
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208VP0014X Pain Medicine
Specialization: Interventional Pain Medicine
200000410 NC Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NC 891269N 05
NC DEA BE5025487 01

Office Location

Street Address 170 MEDICAL PARK RD
SUITE 301
City MOORESVILLE
State NC
Zip Code 28117-8540

Providers in the same location

NPI Name Taxonomy Address Enumeration
1942205521 Carmella Gismondi-eagan Internal Medicine 170 Medical Park Rd, Ste 140a, Mooresville, NC 28117-8540 2005-06-20
1851803829 Anusha Kapadia Nurse Practitioner 170 Medical Park Rd, Ste 140a, Mooresville, NC 28117-8540 2017-10-31
1942667027 Emily Ventre Nurse Practitioner 170 Medical Park Rd, Mooresville, NC 28117 2016-01-21
1710313796 Lynn Barrier Barringer Nurse Practitioner 170 Medical Park Rd, Mooresville, NC 28117-8540 2013-09-23
1497032304 Mooresville Ppm LLC Orthopaedic Surgery 170 Medical Park Rd, Suite 102, Mooresville, NC 28117-8540 2011-11-05
1992003339 Interventional Pain Management of Lake Norman Pllc Pain Medicine 170 Medical Park Rd, Suite 301, Mooresville, NC 28117-8540 2011-03-09
1245486414 Novant Medical Group, Inc. Internal Medicine 170 Medical Park Rd, Suite 140, Mooresville, NC 28117-8540 2008-08-07
1811151244 Carolinas Physicians Network Inc Internal Medicine 170 Medical Park Rd, Ste 140a, Mooresville, NC 28117-8540 2008-07-15
1194914655 Carolina Spine & Pain Center, Pllc Pain Medicine 170 Medical Park Rd, Suite 310, Mooresville, NC 28117-8540 2007-10-22
1932294717 Maje D. Goodwin Pediatrics 170 Medical Park Rd, Suite 102a, Mooresville, NC 28117 2006-10-04
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1891356648 Teleoptometric Service, P.C. Optometrist 392 Talbert Rd, Mooresville, NC 28117 2019-06-24
1992268544 Costco Wholesale Corporation Eyewear Supplier (Equipment, not the service) 392 Talbert Rd., Mooresville, NC 28117 2019-04-10
1982178042 Langtree Endoscopy Center, LLC Clinic/Center 106 Alexander Bank Drive, Suite 101, Mooresville, NC 28117 2019-01-11
1679044416 May and Associates Therapy Center Psychologist 862 Brawley School Road, Suite 202, Mooresville, NC 28117 2018-12-05
1700360153 Sabrina Chabot Hutchinson Physical Therapist 508 Williamson Rd, Suite 200, Mooresville, NC 28117 2018-09-21
1992284327 Presbyterian Imaging Centers LLC Radiology 106 Langtree Village Dr # 201, Mooresville, NC 28117 2018-08-07
1073091310 Jenelle Donzelli Nemeth Registered Nurse 102 Sapphire Drive, Mooresville, NC 28117 2018-07-30
1912497496 Patsharx LLC Pharmacy 480 River Hwy, Suite A, Mooresville, NC 28117 2018-05-10
1427502434 Counseling Service At Lake Norman, Pllc Community/Behavioral Health 18117 W. Catawba Avenue, Cornelius, NC 28117 2016-08-08
1447605928 Renewal Counseling, Pllc Counselor 125 Commerce Park Rd., Suite 102, Mooresville, NC 28117 2016-05-03
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Taxonomy Information

Taxonomy Code 208VP0014X
Grouping Allopathic & Osteopathic Physicians
Classification Pain Medicine
Specialization Interventional Pain Medicine

Taxonomy Definition

Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1992003339 Interventional Pain Management of Lake Norman Pllc Pain Medicine 170 Medical Park Rd, Suite 301, Mooresville, NC 28117-8540 2011-03-09
1194914655 Carolina Spine & Pain Center, Pllc Pain Medicine 170 Medical Park Rd, Suite 310, Mooresville, NC 28117-8540 2007-10-22
1790773000 Mark C Hines Pain Medicine 170 Medical Park Rd, Suite 310, Mooresville, NC 28117-8540 2005-10-11

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1306317011 United Spine & Pain PC Pain Medicine 855 Bradley St Ste A, Concord, NC 28025-2979 2018-12-07
1144604273 Justis Group of Edenton Pain Medicine 905 Cherry St, North Wilkesboro, NC 28659-4251 2015-07-18
1578968079 Carolinas Center for Advanced Management of Pain Pain Medicine 2569 Pembroke Rd, Gastonia, NC 28054-4712 2014-10-27
1255351110 Scott Richard Johnston Pain Medicine 250 Huff Dr, Jacksonville, NC 28546-7369 2006-07-20
1558366385 Sunil K Arora Pain Medicine 1602 Physicians Dr, Suite 103, Wilmington, NC 28401-7363 2005-06-17
1528063542 Center for Pain Management Pllc Pain Medicine 1602 Physicians Dr Ste 103, Wilmington, NC 28401-7350 2005-06-16
1992310502 Southeastern Pain and Wellness, Pllc Pain Medicine 402 W King St, King, NC 27021-9170 2020-09-10
1710592399 Triangle Pain Institute Pain Medicine 2605 Blue Ridge Rd Ste 330, Raleigh, NC 27607-6475 2020-09-10
1144863358 Envision Pain Management Pllc Pain Medicine 107 Haywood Park Dr, Clyde, NC 28721-4405 2019-10-21
1518438811 Medical Innovations Concepts, P.C. Pain Medicine 294 N Nc 16 Business Hwy Ste B, Denver, NC 28037-8741 2018-12-12
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Competitor

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City MOORESVILLE
Zip Code 28117

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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