1316065311 NPI number — HOSPITAL TRAVELER

Table of content: (NPI 1316065311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316065311 NPI number — HOSPITAL TRAVELER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL TRAVELER
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:
1316065311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72014
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27722-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-396-5263
Provider Business Mailing Address Fax Number:
704-973-9636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6221 AMED RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAHAMA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27503-9704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-396-5263
Provider Business Practice Location Address Fax Number:
704-973-9636
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
602-396-5263

Provider Taxonomy Codes

  • Taxonomy code: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200376570 A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 443144 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: V06724 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200123710 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1509453 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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