1154322063 NPI number — PILOT MEDICAL ASSOCIATES

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 1154322063 NPI number — PILOT MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PILOT MEDICAL ASSOCIATES
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:
1154322063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
4804 NC HWY 268 EAST
Provider Business Mailing Address City Name:
PILOT MTN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27041-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-368-2232
Provider Business Mailing Address Fax Number:
336-368-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213C E MARION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PILOT MTN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27041-8535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-368-1070
Provider Business Practice Location Address Fax Number:
336-368-1071
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
336-368-2232

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 89129N0 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com