1184616435 NPI number — DR. DAVID CURTIS HILLSGROVE MD

Table of content: DR. DAVID CURTIS HILLSGROVE MD (NPI 1184616435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184616435 NPI number — DR. DAVID CURTIS HILLSGROVE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLSGROVE
Provider First Name:
DAVID
Provider Middle Name:
CURTIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1184616435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 PARK RD
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:
28209-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-323-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 WELTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-9163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-323-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2005

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: 207X00000X , with the licence number:  9400839 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42439 . This is a "BCBS INDIVIDUAL ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DE4365 . This is a "RAILROAD MEDICARE GROUP ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4519120001 . This is a "PALMETTO GBA DMERC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8942439 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015XT . This is a "BCBS GROUP ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89015XT . This is a "MEDICAID GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 200045187 . This is a "RAILROAD MEDICARE INDIVIDUAL ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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