1316344195 NPI number — FAMILY FIRST MEDICAL CENTER, PLLC

Table of content: AMY LORENZE RN, BSN (NPI 1538501762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316344195 NPI number — FAMILY FIRST MEDICAL CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST MEDICAL CENTER, 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:
1316344195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 RUNNING HORSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-7232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-575-5064
Provider Business Mailing Address Fax Number:
704-243-7506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4822 ALBEMARLE RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28205-6668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-575-5064
Provider Business Practice Location Address Fax Number:
704-243-7506
Provider Enumeration Date:
11/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NWAUCHE
Authorized Official First Name:
CECILIA
Authorized Official Middle Name:
NKASIOBI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-575-5064

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  5006397 , 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)





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