1275647885 NPI number — CENTER FOR ADULT AND FAMILY MEDICINE PA

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 1275647885 NPI number — CENTER FOR ADULT AND FAMILY MEDICINE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ADULT AND FAMILY MEDICINE PA
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:
CENTER FOR ADULT MEDICINE, PA
Provider Other Organization Name Type Code:
4
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:
1275647885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 SAINT FRANCIS DR
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29601-3965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-627-1220
Provider Business Mailing Address Fax Number:
864-627-1221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 SAINT FRANCIS DR
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29601-3965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-627-1220
Provider Business Practice Location Address Fax Number:
864-627-1221
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHTER
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER ADMINISTRATOR
Authorized Official Telephone Number:
864-627-1220

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  22970 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 17244 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 21280 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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