1700051257 NPI number — FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.

Table of content: MS. SOFIA CRISTINA BELAL MSED (NPI 1831742469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700051257 NPI number — FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST FOUNDATION CLINIC OF THE CAROLINAS, INC.
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:
1700051257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28034-0578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-923-0446
Provider Business Mailing Address Fax Number:
704-923-8319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 GAMBLE DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LINCOLNTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28092-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-748-6900
Provider Business Practice Location Address Fax Number:
704-748-9788
Provider Enumeration Date:
04/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JAMERSON
Authorized Official First Name:
THIRRFERN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
704-923-0446

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0233U . This is a "BCBS OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89016MC , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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