1548276389 NPI number — FIRSTHEALTH OF THE CAROLINAS, INC.

Table of content: (NPI 1548276389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548276389 NPI number — FIRSTHEALTH OF THE CAROLINAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRSTHEALTH OF THE CAROLINAS, 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:
FIRSTHEALTH MONTGOMERY MEMORIAL HOSPITAL - FAMILY CARE CENTER - TROY
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:
1548276389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
522 ALLEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27371-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-571-5510
Provider Business Mailing Address Fax Number:
910-571-5572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
522 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27371-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-571-5510
Provider Business Practice Location Address Fax Number:
910-571-5539
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEJACO
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-715-1913

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  200401306 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , 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: 343431A RURAL HEALTH , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0296M . This is a "BCBS GROUP #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89296M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com