1073855870 NPI number — SOUTHERN PINES WOMENS HEALTH CENTER PC

Table of content: (NPI 1073855870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073855870 NPI number — SOUTHERN PINES WOMENS HEALTH CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN PINES WOMENS HEALTH CENTER PC
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:
1073855870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28388-0749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-692-7928
Provider Business Mailing Address Fax Number:
910-692-5962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 TEAL DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
RAEFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28376-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-848-0170
Provider Business Practice Location Address Fax Number:
910-904-7427
Provider Enumeration Date:
03/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
CARPENTER
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
910-684-1532

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7902698 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE8410 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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