1093198400 NPI number — ADAM R BLUMER, DMD PC

Table of content: MS. MELINDA ROBIN TUCKER LCSW (NPI 1063763738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093198400 NPI number — ADAM R BLUMER, DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAM R BLUMER, DMD 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:
CAROLINA CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Provider Other Organization Name Type Code:
3
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:
1093198400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 POWELL MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29301-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-574-2011
Provider Business Mailing Address Fax Number:
864-576-7377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 POWELL MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29301-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-574-2011
Provider Business Practice Location Address Fax Number:
864-576-7377
Provider Enumeration Date:
07/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BLUMER
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-574-2011

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  8500 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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