1386213841 NPI number — SARA ANN HUFFMAN PTA

Table of content: SARA ANN HUFFMAN PTA (NPI 1386213841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386213841 NPI number — SARA ANN HUFFMAN PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUFFMAN
Provider First Name:
SARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORRAL
Provider Other First Name:
SARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386213841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1521 BRIDFORD PKWY # PRKW14F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27407-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-420-6860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 MEADOWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27409-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-299-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2021

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: 225200000X , with the licence number:  A7454 , 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)