1568414464 NPI number — RUSSELL BRYANT STONE OD

Table of content: MICHAEL XU O.D. (NPI 1578626404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568414464 NPI number — RUSSELL BRYANT STONE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
RUSSELL
Provider Middle Name:
BRYANT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1568414464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2402 MONTGOMERY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27393-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-243-2020
Provider Business Mailing Address Fax Number:
252-291-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2402 MONTGOMERY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27393-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-243-2020
Provider Business Practice Location Address Fax Number:
252-291-2020
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1879 , 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: 89093KU , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568414464 . This is a "NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2200355 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0312480001 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: B9760 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 093KW . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P00249058 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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