1669701306 NPI number — DRX HIGH POINT, PLLC

Table of content: (NPI 1669701306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669701306 NPI number — DRX HIGH POINT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRX HIGH POINT, PLLC
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:
DOCTORS EXPRESS
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:
1669701306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 FRESHWATER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28117-5829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-660-0232
Provider Business Mailing Address Fax Number:
336-885-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1231 EASTCHESTER DR
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-884-4050
Provider Business Practice Location Address Fax Number:
336-885-4050
Provider Enumeration Date:
12/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
NANETTE
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
CENTER ADMINISTRATOR
Authorized Official Telephone Number:
704-660-0232

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  200501450 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2075562 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".