1336380294 NPI number — CMC-NORTHEAST, INC.

Table of content: TRACI WEST CERTIFIED OCCUPATION (NPI 1740342138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336380294 NPI number — CMC-NORTHEAST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMC-NORTHEAST, 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:
Provider Other Organization Name Type Code:
6
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:
1336380294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 CHURCH ST N
Provider Second Line Business Mailing Address:
OB/GYN HOSPITALISTS
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-403-1632
Provider Business Mailing Address Fax Number:
704-403-1356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 CHURCH ST N
Provider Second Line Business Practice Location Address:
OB/GYN HOSPITALISTS
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-1632
Provider Business Practice Location Address Fax Number:
704-403-1356
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOWDER
Authorized Official First Name:
FRIEDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR VP OF PHYSICIAN NETWORK
Authorized Official Telephone Number:
704-403-4146

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5911753 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF8926 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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