1053367086 NPI number — CAROLINA KIDNEY ASSOCIATES

Table of content: ANNA SPAIN (NPI 1902257017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053367086 NPI number — CAROLINA KIDNEY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA KIDNEY ASSOCIATES
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:
1053367086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 NEW STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-3654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-379-9708
Provider Business Mailing Address Fax Number:
336-379-8714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 FOUST STREET
Provider Second Line Business Practice Location Address:
CAROLINA KIDNEY ASSOCIATES PA
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-626-0443
Provider Business Practice Location Address Fax Number:
336-379-8714
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCASKILL
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PERSONNEL MANAGER
Authorized Official Telephone Number:
336-379-9708

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01598 . This is a "CKA'S BCBS GP PROV #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CD6638 . This is a "CKA'S RRM GP PROV #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8901598 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com