1659319325 NPI number — WINCARE, INC.

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 1659319325 NPI number — WINCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINCARE, INC.
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:
1659319325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/30/2021
NPI Reactivation Date:
07/15/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-0276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-937-2080
Provider Business Mailing Address Fax Number:
252-937-4660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1558 S. WINSTEAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27803-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-937-2080
Provider Business Practice Location Address Fax Number:
252-937-4660
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUDDICK
Authorized Official First Name:
AMY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
252-937-2080

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0467F . This is a "BLUE CROSS BLUE SHIELD FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100347340A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7586819301 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7702534 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009107231 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0467F . This is a "BLUE CROSS BLUE SHIELD OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 263113 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0467F . This is a "BLUE CROSS BLUE SHIELD FE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DM1152 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0467F . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0467F . This is a "STATE OF NC TEACHERS AND" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 263113 . This is a "ANTHEM BLUE CROSS BLUE SHIELD OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0467F . This is a "STATE OF NC TEACHERS AND STATE EMPLOYEES" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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