1831495225 NPI number — MIDDLEWAY SYSTEMIC SOLUTIONS, PLLC

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 1831495225 NPI number — MIDDLEWAY SYSTEMIC SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLEWAY SYSTEMIC SOLUTIONS, PLLC
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:
1831495225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7413 SIX FORKS RD
Provider Second Line Business Mailing Address:
#208
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-6164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-971-9317
Provider Business Mailing Address Fax Number:
919-710-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8404 SIX FORKS RD
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-3072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-971-9317
Provider Business Practice Location Address Fax Number:
919-710-8228
Provider Enumeration Date:
02/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
RONELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL PSYCHOTHERAPIST
Authorized Official Telephone Number:
919-971-9317

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1292 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 1292 , 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)





Copyright © 2007-2024 www.npivalidator.com