1134457252 NPI number — MRS. AMANDA BATES SLOCUM M.S.N., N.P. - C

Table of content: MRS. AMANDA BATES SLOCUM M.S.N., N.P. - C (NPI 1134457252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134457252 NPI number — MRS. AMANDA BATES SLOCUM M.S.N., N.P. - C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOCUM
Provider First Name:
AMANDA
Provider Middle Name:
BATES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.N., N.P. - C
Provider Gender Code:
F

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:
1134457252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60099
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-355-4593
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 MOREHEAD MEDICAL DR FL 3
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-2963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-355-4593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2009

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: 363LF0000X , with the licence number:  195409 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP1596 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134457252 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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