1578747507 NPI number — BRYAN R NEUWIRTH DDS MD PC

Table of content: (NPI 1578747507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578747507 NPI number — BRYAN R NEUWIRTH DDS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYAN R NEUWIRTH DDS MD PC
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:
1578747507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261 18TH ST CR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28602-1362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-327-7867
Provider Business Mailing Address Fax Number:
828-327-6299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 18TH ST CR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28602-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-327-7867
Provider Business Practice Location Address Fax Number:
828-327-6299
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCKENZIE
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
828-327-7867

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  36121 , 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: 2339122 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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