1215596135 NPI number — PAIN MANAGEMENT PLUS PLLC

Table of content: (NPI 1215596135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215596135 NPI number — PAIN MANAGEMENT PLUS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MANAGEMENT PLUS PLLC
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:
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:
1215596135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYSON CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28713-1641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-279-5801
Provider Business Mailing Address Fax Number:
828-538-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-3585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-279-5801
Provider Business Practice Location Address Fax Number:
828-919-2394
Provider Enumeration Date:
06/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HEWITT
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-919-2393

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6815645 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DZ3967 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 02FLR . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1215596135 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPC102 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: J277 . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 10125636 . This is a "MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: QY95 . This is a "BLUE MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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