1356391833 NPI number — DR. JOSEPH BEAMAN WICKER M.D.

Table of content: DR. JOSEPH BEAMAN WICKER M.D. (NPI 1356391833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356391833 NPI number — DR. JOSEPH BEAMAN WICKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WICKER
Provider First Name:
JOSEPH
Provider Middle Name:
BEAMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANESTHESIA ASSOCIATES
Provider Other First Name:
MOORE
Provider Other Middle Name:
COUNTY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356391833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28374-5249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-295-2920
Provider Business Mailing Address Fax Number:
910-295-4640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 CANTER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374-8666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-295-2920
Provider Business Practice Location Address Fax Number:
910-295-4640
Provider Enumeration Date:
05/12/2006

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: 207L00000X , with the licence number:  26166 , 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: 87317 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8987269 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q26166 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1323X . This is a "BC OF NC STATE HEALTH PLA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com