1932160207 NPI number — PINEWEST OBGYN INC

Table of content: (NPI 1932160207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932160207 NPI number — PINEWEST OBGYN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINEWEST OBGYN 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:
1932160207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262-6415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-885-0149
Provider Business Mailing Address Fax Number:
336-885-0101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 WESTWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-4341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-885-0149
Provider Business Practice Location Address Fax Number:
336-885-0101
Provider Enumeration Date:
03/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELBORN
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
336-885-0149

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: 8902425 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".