1245335066 NPI number — FHPG, LLC

Table of content: (NPI 1245335066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245335066 NPI number — FHPG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FHPG, LLC
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:
FIRSTHEALTH FAMILY MEDICINE-RAEFORD
Provider Other Organization Name Type Code:
3
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:
1245335066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-904-2350
Provider Business Mailing Address Fax Number:
910-904-1037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 TEAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAEFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28376-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-904-2350
Provider Business Practice Location Address Fax Number:
910-904-1037
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DENNIS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
910-715-5181

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0188P . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1245335066 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02AY3 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8902800 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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