1497739189 NPI number — BT HEART AND VASCULAR CENTER, 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 1497739189 NPI number — BT HEART AND VASCULAR CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BT HEART AND VASCULAR CENTER, 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:
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:
1497739189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 CHARLOIS BLVD
Provider Second Line Business Mailing Address:
SUITE 223
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-765-2500
Provider Business Mailing Address Fax Number:
336-765-2555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 CHARLOIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-765-2500
Provider Business Practice Location Address Fax Number:
336-765-2555
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TAGHIZADEH
Authorized Official First Name:
BEHZAD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
336-765-2500

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  124240 , 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: 1528049269 . This is a "PAULA CARTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1750362430 . This is a "DR. KENNETH RHINEHART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003888066 . This is a "THEODORE KEITH, JR., MD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275514986 . This is a "DR. BEHZAD TAGHIZADEH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1386843498 . This is a "AMY SPETZ, PA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1538112529 . This is a "TIFFANY SPEAS, PA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DC6367 . This is a "MEDICARE RR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5900341 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1629037387 . This is a "ALFRED RUFTY, JR., MD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0294L . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1134191273 . This is a "CHARLES W HARRIS, JR., MD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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