1073769246 NPI number — NORTH CAROLINA INPATIENT MEDICINE ASSOCIATES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073769246 NPI number — NORTH CAROLINA INPATIENT MEDICINE ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA INPATIENT MEDICINE ASSOCIATES PLLC
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:
1073769246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30355-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-397-0060
Provider Business Mailing Address Fax Number:
678-397-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
566 RUIN CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-436-1352
Provider Business Practice Location Address Fax Number:
252-436-1351
Provider Enumeration Date:
08/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
TALBOT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
VP CLINICAL SERVICES
Authorized Official Telephone Number:
678-397-0060

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5950118 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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