1053534446 NPI number — HAMLET PODIATRY, PC

Table of content: (NPI 1053534446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053534446 NPI number — HAMLET PODIATRY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMLET PODIATRY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053534446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKINGHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28380-8328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-582-0007
Provider Business Mailing Address Fax Number:
910-582-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 WILLIAMS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMLET
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28345-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-582-0007
Provider Business Practice Location Address Fax Number:
910-582-8070
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
REMBERT
Authorized Official Middle Name:
ALPHONSO
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
910-582-0007

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  341 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08025 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890803M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0803M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5950762 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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