1689637613 NPI number — DR. RALPH EVERETT OURSLER III M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689637613 NPI number — DR. RALPH EVERETT OURSLER III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OURSLER
Provider First Name:
RALPH
Provider Middle Name:
EVERETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1689637613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28603-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-322-2050
Provider Business Mailing Address Fax Number:
704-732-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 CENTURY PL SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-4031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-322-2050
Provider Business Practice Location Address Fax Number:
828-345-0522
Provider Enumeration Date:
04/10/2006

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: 207W00000X , with the licence number:  900316 , 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: 1689637613 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5403578 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 11481674 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1853256 . This is a "WELLCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5403548 . This is a "ENVOLVE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A03459 . This is a "EYEMED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1235C . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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