1477515039 NPI number — HENDERSONVILLE OB-GYN ASSOCIATES, P.A.

Table of content: CYDNEE L WIDNER MS ATC LAT (NPI 1306303839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477515039 NPI number — HENDERSONVILLE OB-GYN ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDERSONVILLE OB-GYN ASSOCIATES, P.A.
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:
1477515039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 DOCTORS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-687-3800
Provider Business Mailing Address Fax Number:
828-687-1814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 DOCTORS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28792-7209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-687-3800
Provider Business Practice Location Address Fax Number:
828-687-1814
Provider Enumeration Date:
04/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARCARA
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
828-692-2258

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7901782 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01782 . This is a "BCBS OF NC ID#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".