1164491296 NPI number — DR. DEAN A PAGE M.D.

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 1164491296 NPI number — DR. DEAN A PAGE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGE
Provider First Name:
DEAN
Provider Middle Name:
A
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:
1164491296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 WOODSIDE EXECUTIVE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29803-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-642-0277
Provider Business Mailing Address Fax Number:
803-641-4277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W TEMPLE AVE STE 2500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-540-2350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006

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: 174400000X , with the licence number:  21914 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 036157974 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 219142 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 571096050 . This is a "FEDERAL TAX ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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