1033105291 NPI number — MARY BOGGS LANE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033105291 NPI number — MARY BOGGS LANE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
MARY
Provider Middle Name:
BOGGS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1033105291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHEROKEE COUNTY HEALTH DEPARTMENT
Provider Second Line Business Mailing Address:
228 HILTON STREET
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28906-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-837-7486
Provider Business Mailing Address Fax Number:
828-835-7854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHEROKEE COUNTY HEALTH DEPARTMENT
Provider Second Line Business Practice Location Address:
228 HILTON STREET
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28906-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-837-7486
Provider Business Practice Location Address Fax Number:
828-835-7854
Provider Enumeration Date:
09/23/2005

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: 207Q00000X , with the licence number:  32508 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 32508 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VG0400X , with the licence number: 32508 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 890288N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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