1265584874 NPI number — MR. CLAUDE P DUFOUR PAC

Table of content: MR. CLAUDE P DUFOUR PAC (NPI 1265584874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265584874 NPI number — MR. CLAUDE P DUFOUR PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFOUR
Provider First Name:
CLAUDE
Provider Middle Name:
P
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1265584874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1528
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-642-6121
Provider Business Mailing Address Fax Number:
910-642-8457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-6121
Provider Business Practice Location Address Fax Number:
910-642-8457
Provider Enumeration Date:
01/17/2007

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: 363AM0700X , with the licence number:  100591 , 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: 82478 . This is a "BLUE CROSS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0120143 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110017485 . This is a "RR MCR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8982478 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: N20979 . This is a "SC MCD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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