1528300746 NPI number — O-AYSIST, 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 1528300746 NPI number — O-AYSIST, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O-AYSIST, 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:
1528300746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 PALMETTO CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28546-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-265-5035
Provider Business Mailing Address Fax Number:
910-333-1036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 WESTERN BLVD STE Q
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-6852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-519-2321
Provider Business Practice Location Address Fax Number:
910-333-1036
Provider Enumeration Date:
03/26/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RYANS
Authorized Official First Name:
ABREE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
910-265-5035

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  5004793 , 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)