1679758759 NPI number — CABARRUS FAMILY MEDICINE

Table of content: (NPI 1679758759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679758759 NPI number — CABARRUS FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CABARRUS FAMILY MEDICINE
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:
1679758759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 COPPERFIELD BLVD NE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-2441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-721-2090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 COPPERFIELD BLVD NE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-721-2090
Provider Business Practice Location Address Fax Number:
704-721-7424
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
704-721-2062

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 017KU . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89012UV , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89012UW , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ2206 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 348937 . This is a "MEDICARE RURAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89012UT , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89012UU , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89013T2 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 348937A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89015EG , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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