1306981923 NPI number — MELANGE HEALTH SOLUTIONS, LLC

Table of content: (NPI 1306981923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306981923 NPI number — MELANGE HEALTH SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELANGE HEALTH SOLUTIONS, LLC
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:
1306981923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28229-9234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-567-8690
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 SCALEYBARK RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-2687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-567-8690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
GARDNER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
704-567-8690

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 8301351 , 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: 6005873 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301351 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301531G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301351H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302355H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302355 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302355B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301351B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302355G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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