1184677635 NPI number — PAUL N ERCKMAN MD

Table of content: (NPI 1184677635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184677635 NPI number — PAUL N ERCKMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL N ERCKMAN MD
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:
MONROE CHILDRENS CENTER
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:
1184677635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307B EAST FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-289-2556
Provider Business Mailing Address Fax Number:
704-282-1282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307B EAST FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-289-2556
Provider Business Practice Location Address Fax Number:
704-282-1282
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ERCKMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
704-289-2556

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 16277 , 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: 8930740 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30740 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4491873 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 249124 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: N16277 . This is a "SC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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