1720476997 NPI number — MS. RACHEL LYNNE SADDLEMIRE PTA

Table of content: BARBARA EVANS (NPI 1518359645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720476997 NPI number — MS. RACHEL LYNNE SADDLEMIRE PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADDLEMIRE
Provider First Name:
RACHEL
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SADDLEMIRE
Provider Other First Name:
RACHEL
Provider Other Middle Name:
SADDLEMIRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720476997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 COOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27249-2945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-970-1386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3895 OLD VINEYARD 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:
27104-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-970-1486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2014

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: 208100000X , with the licence number:  A4460 , 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)





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