1689804189 NPI number — DAVID A. PLANK, L.C.S.W., P.A.

Table of content: (NPI 1689804189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689804189 NPI number — DAVID A. PLANK, L.C.S.W., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A. PLANK, L.C.S.W., P.A.
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:
1689804189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27404-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-833-3253
Provider Business Mailing Address Fax Number:
336-274-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 N GREENE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-833-3253
Provider Business Practice Location Address Fax Number:
336-274-4299
Provider Enumeration Date:
07/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PLANK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
336-833-3253

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C002926 , 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: 73978 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1243A . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".