1437142775 NPI number — AEGIS FAMILY HEALTH CENTERS INC

Table of content: (NPI 1437142775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437142775 NPI number — AEGIS FAMILY HEALTH CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AEGIS FAMILY HEALTH CENTERS 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:
AEGIS FAMILY HEALTH CENTERS YADKINVILLE
Provider Other Organization Name Type Code:
3
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:
1437142775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YADKINVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27055-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-679-6700
Provider Business Mailing Address Fax Number:
336-679-6733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YADKINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27055-7804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-679-6700
Provider Business Practice Location Address Fax Number:
336-679-6733
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
THORP
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
336-659-5116

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 890216V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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