1346327707 NPI number — SIGNET HEALTHCARE, PC

Table of content: (NPI 1346327707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346327707 NPI number — SIGNET HEALTHCARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNET HEALTHCARE, PC
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:
1346327707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1527
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-642-0300
Provider Business Mailing Address Fax Number:
910-640-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 HILL PLZ STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-0300
Provider Business Practice Location Address Fax Number:
910-640-3327
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-642-0300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  36494 , 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: 44960 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "EMPIRE BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "OPTION BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CK5068 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPB005 . This is a "SOUTH CAROLINA MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "FEDERAL BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4140662NC . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7067596009 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "BLUECROSS BLUESHIELD STATE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110069099 . This is a "PALMETTA GBA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 216449 . This is a "COVENTRY HEALTHCARE PLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89013UY , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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