1114987476 NPI number — NORTHEAST ORTHOPEDICS PA

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 1114987476 NPI number — NORTHEAST ORTHOPEDICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST ORTHOPEDICS PA
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:
1114987476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28026-6002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-788-3155
Provider Business Mailing Address Fax Number:
704-785-8302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
354 COPPERFIELD BLVD, NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-788-3155
Provider Business Practice Location Address Fax Number:
704-785-8302
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
704-788-3155

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8902666 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG1491 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3683 . This is a "PARTNERS MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02666 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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