1053435180 NPI number — KIGHTS MEDICAL CORP

Table of content: (NPI 1053435180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053435180 NPI number — KIGHTS MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIGHTS MEDICAL CORP
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:
1053435180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3222 WELLINGTON CT
Provider Second Line Business Mailing Address:
STE. A
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-878-6666
Provider Business Mailing Address Fax Number:
919-878-4411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
572 GRIFFITH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-848-1179
Provider Business Practice Location Address Fax Number:
704-525-6225
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIGHT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
919-878-6666

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  00562 , 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: DE2019 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15527 . This is a "WELLPATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0303780332 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0464T . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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