1265407175 NPI number — CAROLINAS ANSON HEALTHCARE INC.

Table of content: (NPI 1265407175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265407175 NPI number — CAROLINAS ANSON HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS ANSON HEALTHCARE INC.
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:
CAROLINAS HEALTHCARE SYSTEM ANSON
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:
1265407175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 US HIGHWAY 74 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28170-7554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-994-4500
Provider Business Mailing Address Fax Number:
704-994-4501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 US HIGHWAY 74 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-7554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-994-4500
Provider Business Practice Location Address Fax Number:
704-994-4501
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
704-695-3402

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC1119 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H0082 , 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: 407241 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3408242 . This is a "CAP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0045047 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134684 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3400084 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPA952 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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