1639176829 NPI number — EDUARDO SANMIGUEL MD

Table of content: EDUARDO SANMIGUEL MD (NPI 1639176829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639176829 NPI number — EDUARDO SANMIGUEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANMIGUEL
Provider First Name:
EDUARDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1639176829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENANSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28349-8801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-296-2774
Provider Business Mailing Address Fax Number:
910-296-2771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4402 SHIPYARD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-6161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-452-1400
Provider Business Practice Location Address Fax Number:
910-332-1072
Provider Enumeration Date:
07/01/2005

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: 207P00000X , with the licence number:  9900341 , 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: 1191T . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: Q00345 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891191T , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-28699 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 930077044 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: B4557 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 930084657 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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