1023073517 NPI number — MRS. SYLVIA S MEADS ROFM

Table of content: MRS. SYLVIA S MEADS ROFM (NPI 1023073517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023073517 NPI number — MRS. SYLVIA S MEADS ROFM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADS
Provider First Name:
SYLVIA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ROFM
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:
1023073517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1471
Provider Second Line Business Mailing Address:
106 MEDICAL DRIVE
Provider Business Mailing Address City Name:
ELIZ CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-338-3002
Provider Business Mailing Address Fax Number:
252-338-2902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZ CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-338-3002
Provider Business Practice Location Address Fax Number:
252-338-2902
Provider Enumeration Date:
04/19/2006

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: 225000000X , with the licence number:  CFOM0204 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 229N00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , 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: 384410 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7701327 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0482P . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7795160 . This is a "INDIVID EDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9190511 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com