1194823252 NPI number — DR. RUFUS B OVERCASH JR. DC

Table of content: DR. RUFUS B OVERCASH JR. DC (NPI 1194823252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194823252 NPI number — DR. RUFUS B OVERCASH JR. DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVERCASH
Provider First Name:
RUFUS
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1194823252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 49343
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-0077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-540-4293
Provider Business Mailing Address Fax Number:
704-540-4930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15105 JOHN J DELANEY DR
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-540-4293
Provider Business Practice Location Address Fax Number:
704-540-4930
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2719 , 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: 89085M7 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 612672 . This is a "ACN PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 085M7 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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