1588836720 NPI number — DR. GARY FIKE JR. AUD

Table of content: DR. GARY FIKE JR. AUD (NPI 1588836720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588836720 NPI number — DR. GARY FIKE JR. AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIKE
Provider First Name:
GARY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
AUD
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:
1588836720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 BEN CASEY DR.
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
FORT MILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29708-8557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-547-4327
Provider Business Mailing Address Fax Number:
803-547-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 BEN CASEY DR.
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FORT MILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29708-8557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-547-4327
Provider Business Practice Location Address Fax Number:
803-547-4329
Provider Enumeration Date:
03/27/2008

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: 231H00000X , with the licence number:  5785 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 1077 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 3913 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0024571 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1629T . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7413287 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9066225 . This is a "AENTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01285347 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: SAN076 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30105375 . This is a "SELECT HEALTH OF SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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