1073982443 NPI number — Q1 CLINICAL CONSULTANTS, LLC

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 1073982443 NPI number — Q1 CLINICAL CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Q1 CLINICAL CONSULTANTS, LLC
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:
1073982443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 W WILLIAMS ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27502-3979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-303-5377
Provider Business Mailing Address Fax Number:
919-303-5380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 HUNTER LN
Provider Second Line Business Practice Location Address:
ZEBULON
Provider Business Practice Location Address City Name:
ZEBULON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27597-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-303-5377
Provider Business Practice Location Address Fax Number:
919-303-5380
Provider Enumeration Date:
09/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
MATISHA
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
919-303-5377

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418501 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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