1174509244 NPI number — DRS A MASON AHEARN & WRIGHT G SKINNER III

Table of content: (NPI 1174509244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174509244 NPI number — DRS A MASON AHEARN & WRIGHT G SKINNER III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS A MASON AHEARN & WRIGHT G SKINNER III
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:
BAY ORTHOPEDIC ASSOCIATION LLC
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:
1174509244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1777
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29442-1777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-527-4447
Provider Business Mailing Address Fax Number:
843-527-6423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 N FRASER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29440-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-527-4447
Provider Business Practice Location Address Fax Number:
843-527-6423
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCCURDY
Authorized Official First Name:
GINI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
843-527-4447

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  AN56 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1447236815 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1255317624 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 200042355 . This is a "RAILROAD PROVIDER NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 200042667 . This is a "RAILROAD PROVIDER NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DM0379 . This is a "MEDICAID DMERC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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