1154518140 NPI number — DEWAIN NICHOLAS SPRINGER

Table of content: (NPI 1154518140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154518140 NPI number — DEWAIN NICHOLAS SPRINGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEWAIN NICHOLAS SPRINGER
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:
NORTH COUNTY PODIATRY CLINICS
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:
1154518140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2191 S EL CAMINO REAL
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92054-6224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-757-7171
Provider Business Mailing Address Fax Number:
760-757-7172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2191 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-6224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-757-7171
Provider Business Practice Location Address Fax Number:
760-757-7172
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPRINGER
Authorized Official First Name:
DEWAIN
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
760-757-7171

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E3097 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com