1720019110 NPI number — AA MANAGEMENT CORP

Table of content: (NPI 1720019110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720019110 NPI number — AA MANAGEMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AA MANAGEMENT CORP
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:
AA PRIMECARE MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1720019110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 HAWTHORNE LN
Provider Second Line Business Mailing Address:
SUITE 110/121
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28204-2484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-333-5606
Provider Business Mailing Address Fax Number:
704-333-5611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 E 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-333-5606
Provider Business Practice Location Address Fax Number:
704-333-5611
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
704-333-5606

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 5905847 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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