1497739189 NPI number — BT HEART AND VASCULAR CENTER, PLLC

Table of content: (NPI 1497739189)

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:
THE HEART AND VASCULAR CENTER
Provider Other Organization Name Type Code:
3
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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