1013099704 NPI number — MS. PEGGY M BINTZ NP

Table of content: MS. PEGGY M BINTZ NP (NPI 1013099704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013099704 NPI number — MS. PEGGY M BINTZ NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINTZ
Provider First Name:
PEGGY
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1013099704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 684
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28758-0684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-697-8471
Provider Business Mailing Address Fax Number:
828-697-8471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
558 FLEMING ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28739-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-697-8471
Provider Business Practice Location Address Fax Number:
828-697-8471
Provider Enumeration Date:
10/20/2006

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: 363LP0808X , with the licence number:  199886 , 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: NCMC038081 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2592478B . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6005048 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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