1558766501 NPI number — NATIONAL INSTITUTE OF TOXICOLOGY, PLLC

Table of content: (NPI 1558766501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558766501 NPI number — NATIONAL INSTITUTE OF TOXICOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL INSTITUTE OF TOXICOLOGY, 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:
1558766501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
956 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27030-3747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-648-8550
Provider Business Mailing Address Fax Number:
336-648-8551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
956 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-3747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-648-8550
Provider Business Practice Location Address Fax Number:
336-648-8551
Provider Enumeration Date:
11/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
LINDSEY
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
336-648-8550

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01953 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34D22080208 . This is a "CLIA CERTIFICATE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 34D2085270 . This is a "CLIA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 70121 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 205233 . This is a "NORTH CAROLINA MEDICAL BOARD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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