1033104914 NPI number — MRS. EMMA W WHITE PT

Table of content: MRS. EMMA W WHITE PT (NPI 1033104914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033104914 NPI number — MRS. EMMA W WHITE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
EMMA
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1033104914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1262 DOVERSHIRE CT
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:
27262-7306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-882-6035
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319A JULIAN AVE
Provider Second Line Business Practice Location Address:
HEALTHCARE CONSULTANTS INC
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27360-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-472-6566
Provider Business Practice Location Address Fax Number:
336-472-5281
Provider Enumeration Date:
09/15/2005

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: 225100000X , with the licence number:  3573 , 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: 561722523 . This is a "WORKERS COMP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4272130 . This is a "QUALCHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 07967 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 56162 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 650012600 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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