1700858404 NPI number — DR. TAMAS SOOS M.D.

Table of content: DR. TAMAS SOOS M.D. (NPI 1700858404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700858404 NPI number — DR. TAMAS SOOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOOS
Provider First Name:
TAMAS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1700858404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YADKINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27055-0249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-679-4963
Provider Business Mailing Address Fax Number:
336-679-2549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 PARKWOOD MEDICAL PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28621-2487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-526-7997
Provider Business Practice Location Address Fax Number:
336-526-3537
Provider Enumeration Date:
02/06/2006

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: 207R00000X , with the licence number:  200001437 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 200001437 , 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: A6462 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 128KN . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2151909 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89128KN , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42110 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7815291 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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