1144371618 NPI number — JOAN D. EVANS, D.P.M., P.A.

Table of content: (NPI 1144371618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144371618 NPI number — JOAN D. EVANS, D.P.M., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOAN D. EVANS, D.P.M., P.A.
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:
TROY FOOT CLINIC
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:
1144371618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 WOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27371-2849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-576-2212
Provider Business Mailing Address Fax Number:
910-576-2212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 WOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27371-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-576-2212
Provider Business Practice Location Address Fax Number:
910-576-2212
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-576-2212

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  264 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 264 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 264 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP1100X , with the licence number: 264 , 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: 0805G . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890805G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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