1114944907 NPI number — DR. ERIC J RENTZ DO

Table of content: DR. ERIC J RENTZ DO (NPI 1114944907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114944907 NPI number — DR. ERIC J RENTZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENTZ
Provider First Name:
ERIC
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1114944907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 LEACROFT WAY
Provider Second Line Business Mailing Address:
ATTN: DR. RENTZ
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-7757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-371-1481
Provider Business Mailing Address Fax Number:
919-371-1481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HONEY BEAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANNER ELK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28604-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-260-5073
Provider Business Practice Location Address Fax Number:
828-898-2452
Provider Enumeration Date:
07/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  9901001 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204D00000X , with the licence number: 02184 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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