1699921999 NPI number — MIDWAY MEDICAL CENTER-CANTON

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 1699921999 NPI number — MIDWAY MEDICAL CENTER-CANTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWAY MEDICAL CENTER-CANTON
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:
1699921999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28716-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-646-0080
Provider Business Mailing Address Fax Number:
828-646-0580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28716-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-646-0080
Provider Business Practice Location Address Fax Number:
855-876-9354
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KINTER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-627-2211

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  62447 , 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: C17128 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4245150001 . This is a "MEDICARE DME" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5900304 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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