1518968056 NPI number — NORTH CAROLINA INTERNAL MEDICINE, P.C

Table of content: (NPI 1518968056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518968056 NPI number — NORTH CAROLINA INTERNAL MEDICINE, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA INTERNAL MEDICINE, P.C
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:
1518968056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 KEISLER DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518-7091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-851-1600
Provider Business Mailing Address Fax Number:
919-851-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 KEISLER DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27518-7091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-851-1600
Provider Business Practice Location Address Fax Number:
919-851-1600
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOLI
Authorized Official First Name:
CHINA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-851-1600

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  9901533 , 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: 161162 . This is a "WELLPATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89012VK , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P117102 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5474498002 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011MP . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110237017 . This is a "MEDI CARE RAIL ROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116245 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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