1609268689 NPI number — FACIALS & FILLERS AESTHETICS CENTER

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 1609268689 NPI number — FACIALS & FILLERS AESTHETICS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACIALS & FILLERS AESTHETICS CENTER
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:
1609268689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5056 HWY 70 W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MOREHEAD CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28557-4502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-240-3223
Provider Business Mailing Address Fax Number:
252-499-9004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5056 HWY 70 W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-240-3223
Provider Business Practice Location Address Fax Number:
252-499-9004
Provider Enumeration Date:
02/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
252-240-3223

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  24073 , 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: 1902095920 . This is a "GENERIC NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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