1851361984 NPI number — DR. WILLIAM JAY MCANINCH PODIATRIST

Table of content: DR. WILLIAM JAY MCANINCH PODIATRIST (NPI 1851361984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851361984 NPI number — DR. WILLIAM JAY MCANINCH PODIATRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCANINCH
Provider First Name:
WILLIAM
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PODIATRIST
Provider Gender Code:
M

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:
1851361984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 WHITE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAULDIN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29662-2533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-329-0655
Provider Business Mailing Address Fax Number:
864-640-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1754 WOODRUFF RD
Provider Second Line Business Practice Location Address:
308
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-5933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-640-4595
Provider Business Practice Location Address Fax Number:
864-640-4553
Provider Enumeration Date:
01/23/2006

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: 213E00000X , with the licence number:  48 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP9973 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com