1447379490 NPI number — DON EDWARD MILLS JR OD PA

Table of content: MARK ALLEN MONROE JR. (NPI 1457808354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447379490 NPI number — DON EDWARD MILLS JR OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DON EDWARD MILLS JR OD PA
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:
1447379490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
492 WILLIAMSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28117-9185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-664-9121
Provider Business Mailing Address Fax Number:
704-664-4886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
492 WILLIAMSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-9185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-664-9121
Provider Business Practice Location Address Fax Number:
704-664-4886
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
704-664-9121

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DQ3416 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 019MM . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com