1184778136 NPI number — CHARLES V. SIKES JR

Table of content: (NPI 1184778136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184778136 NPI number — CHARLES V. SIKES JR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES V. SIKES JR
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:
Provider Other Organization Name Type Code:
6
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:
1184778136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LILLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-893-5711
Provider Business Mailing Address Fax Number:
910-893-4805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 W IVEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LILLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-893-5711
Provider Business Practice Location Address Fax Number:
910-893-4805
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIKES
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-893-5711

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0997 , 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: 09832 . This is a "BCBSNC C. SIKES, JR." identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909827 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0157X . This is a "BCBSNC GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09713 . This is a "BCBSNC L. SMITH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909713 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890157X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410000229 . This is a "RR MEDICARE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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