1164675914 NPI number — METROLINA AIDS PROJECT, INC.

Table of content: (NPI 1164675914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164675914 NPI number — METROLINA AIDS PROJECT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROLINA AIDS PROJECT, INC.
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:
METROLINA CARE NETWORK
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:
1164675914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32662
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28232-2662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-333-1435
Provider Business Mailing Address Fax Number:
704-602-2440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 EXECUTIVE CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28212-8861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-936-4460
Provider Business Practice Location Address Fax Number:
704-936-4470
Provider Enumeration Date:
10/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-333-1435

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2335882 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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