1518054774 NPI number — CW MEDICAL INC

Table of content: (NPI 1518054774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518054774 NPI number — CW MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CW MEDICAL INC
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:
1518054774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2090
Provider Second Line Business Mailing Address:
714-C CAROLINA AVE
Provider Business Mailing Address City Name:
YADKINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27055-2090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-849-0128
Provider Business Mailing Address Fax Number:
336-849-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 CAROLINA AVE # C
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055-7760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-849-0128
Provider Business Practice Location Address Fax Number:
336-849-0130
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-849-0128

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , 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: 1205620001 . This is a "PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7702204 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com