1407185465 NPI number — MEDICAL ASSOCIATES OF ROCK HILL

Table of content: (NPI 1407185465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407185465 NPI number — MEDICAL ASSOCIATES OF ROCK HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ASSOCIATES OF ROCK HILL
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:
1407185465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601586
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:
28260-1586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-328-0181
Provider Business Mailing Address Fax Number:
803-328-0553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13640 STEELECROFT PKWY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28278-7565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-328-0181
Provider Business Practice Location Address Fax Number:
803-328-0553
Provider Enumeration Date:
12/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WIENS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
704-355-0648

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NPB359 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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