1558485318 NPI number — MRS. BENCITA BUGARIN BROOKS SLP

Table of content: MRS. BENCITA BUGARIN BROOKS SLP (NPI 1558485318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558485318 NPI number — MRS. BENCITA BUGARIN BROOKS SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
BENCITA
Provider Middle Name:
BUGARIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

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:
1558485318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6696 OLD 421 S
Provider Second Line Business Mailing Address:
DEEP GAP
Provider Business Mailing Address City Name:
DEEP GAP
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28618-8903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-773-0233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2359 HIGHWAY 105
Provider Second Line Business Practice Location Address:
BOONE
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28607-7814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-265-5391
Provider Business Practice Location Address Fax Number:
828-265-5394
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2297 , 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: 60203 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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