1275580854 NPI number — W SCOTT MOORE ET AL PTR

Table of content: (NPI 1275580854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275580854 NPI number — W SCOTT MOORE ET AL PTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W SCOTT MOORE ET AL PTR
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:
NEPHROLOGY ASSOCIATES, PLLC
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:
1275580854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 HIGHLAND OAKS DRIVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-7108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-768-2425
Provider Business Mailing Address Fax Number:
336-768-4915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 HIGHLAND OAKS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-7108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-768-2425
Provider Business Practice Location Address Fax Number:
336-768-4915
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARRISH
Authorized Official First Name:
BETSY
Authorized Official Middle Name:
ROBBINS
Authorized Official Title or Position:
OFFICE MANGER
Authorized Official Telephone Number:
336-245-6306

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  61281 , 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: 8902199 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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