1497722359 NPI number — ESPIRITU CLINIC PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497722359 NPI number — ESPIRITU CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPIRITU CLINIC PLLC
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:
1497722359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 N CENTER ST
Provider Second Line Business Mailing Address:
370
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28601-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-898-7130
Provider Business Mailing Address Fax Number:
828-322-7921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 FAIRGROVE CHURCH RD SE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CONOVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28613-9290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-898-7130
Provider Business Practice Location Address Fax Number:
828-322-7921
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESPIRITU
Authorized Official First Name:
HERNANE
Authorized Official Middle Name:
BAUTISTA
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
888-898-7130

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 891352X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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