1013975598 NPI number — PINEHURST RHEUMATOLOGY PA

Table of content: (NPI 1013975598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013975598 NPI number — PINEHURST RHEUMATOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINEHURST RHEUMATOLOGY PA
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:
1013975598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4204 MURDOCKSVILLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST END
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27376-8871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-255-0055
Provider Business Mailing Address Fax Number:
910-255-0060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4204 MURDOCKSVILLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST END
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27376-8871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-255-0055
Provider Business Practice Location Address Fax Number:
910-255-0060
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
KARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-255-0055

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1881691277 . This is a "MARTIN NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2320331 . This is a "MEDICARE PTAN ENDING 2/25/2009" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CD8391 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1013975598 . This is a "GROUP NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1780681221 . This is a "AUSTIN NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890136Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2225603A . This is a "MEDICARE GROUP NEW PTAN 2/26/2009" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1710919683 . This is a "SCHORN NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0136Y . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPB124 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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