1154385631 NPI number — DR. MARTIN JOHN SPALDING M.D,

Table of content: HEATHER GOUGH RN (NPI 1386137453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154385631 NPI number — DR. MARTIN JOHN SPALDING M.D,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPALDING
Provider First Name:
MARTIN
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D,
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:
1154385631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2375
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29171-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-936-8146
Provider Business Mailing Address Fax Number:
803-936-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 SUNSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-936-8146
Provider Business Practice Location Address Fax Number:
803-936-8916
Provider Enumeration Date:
04/13/2006

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: 207ZP0102X , with the licence number:  111687 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30544018 . This is a "KANSAS CITY BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100428960A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 204837819 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 314252 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100428960B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 442180 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com