1649239641 NPI number — MDCO PA

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 1649239641 NPI number — MDCO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MDCO PA
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:
NORTH POINT MEDICAL ASSOCIATES; WEST FORSYTH FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
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:
1649239641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1995 BETHABARA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27106-3375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-759-7596
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1995 BETHABARA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27106-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-245-0333
Provider Business Practice Location Address Fax Number:
336-245-0332
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DALTON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
336-759-7596

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9500876 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: 24445 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: 9500759 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 95-00876 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 95-00759 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X , with the licence number: 95-00876 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X , with the licence number: 95-00759 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363AM0700X , with the licence number: 102304 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363AM0700X , with the licence number: 101788 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363AM0700X , with the licence number: 101138 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0222V . This is a "NORTH POINT MEDICAL BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3977 . This is a "PARTNERS WEST FORSYTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0296W . This is a "WEST FORSYTH FAMILY BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 402116 . This is a "UNITED HEALTHCARE WARNMNT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3981 . This is a "PARTNERS NORTH POINT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 402121 . This is a "UNITED HEALTHCARE DALTON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 287314 . This is a "MAMSI LENDLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CN3058 . This is a "NP RAILROAD MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 330206 . This is a "LAB NP & WF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 890222V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890296W , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ5710 . This is a "RAILROAD WF MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102267 . This is a "UNITED HEALTHCARE LENDLE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com