1053595736 NPI number — DR CRYSTAL S HEFNER

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 1053595736 NPI number — DR CRYSTAL S HEFNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR CRYSTAL S HEFNER
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:
1053595736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 582
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONOVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28613-0582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-464-6030
Provider Business Mailing Address Fax Number:
828-465-6339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 1ST ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONOVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28613-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-464-6030
Provider Business Practice Location Address Fax Number:
828-465-6339
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEFNER
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-464-6030

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  NC0990 , 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: NC0990 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 10261 . This is a "OPTICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 271874 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09833 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09833 . This is a "NC HEALTH CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909833 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09833 . This is a "NC STATE EMPLOYEES" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2242466 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909833 . This is a "NC DIVISION OF THE BLIND" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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