1467592402 NPI number — AB&M THERAPY SERVICES

Table of content: (NPI 1467592402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467592402 NPI number — AB&M THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AB&M THERAPY SERVICES
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:
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:
1467592402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 824
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27021-0824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-983-2210
Provider Business Mailing Address Fax Number:
336-983-2218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617 EAST KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-0824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-983-2210
Provider Business Practice Location Address Fax Number:
336-983-2218
Provider Enumeration Date:
02/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWERS
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
BRYTE
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
336-983-2210

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  1802 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X , with the licence number: 5553 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 0018 , 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: 7210573 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326N . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".