1871817270 NPI number — MEDICAL ASSOCIATES OF ROCK HILL

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 1871817270 NPI number — MEDICAL ASSOCIATES OF ROCK HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ASSOCIATES OF ROCK HILL
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:
MEDICAL ASSOCIATES OF FORT MILL
Provider Other Organization Name Type Code:
3
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:
1871817270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28219-9305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-631-0002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 GOLD HILL RD
Provider Second Line Business Practice Location Address:
STE 115
Provider Business Practice Location Address City Name:
FORT MILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29715-8906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-802-5181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RISSMILLER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
ENTERPRISE EVP
Authorized Official Telephone Number:
704-355-8675

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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