1891834131 NPI number — MR. RICHARD NMI VANBENTHUYSEN JR. P.A.

Table of content: MR. RICHARD NMI VANBENTHUYSEN JR. P.A. (NPI 1891834131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891834131 NPI number — MR. RICHARD NMI VANBENTHUYSEN JR. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANBENTHUYSEN
Provider First Name:
RICHARD
Provider Middle Name:
NMI
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
P.A.
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:
1891834131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHERRY HOSPITAL
Provider Second Line Business Mailing Address:
1401 W. ASH STREET
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27530-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-947-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHERRY HOSPITAL
Provider Second Line Business Practice Location Address:
1401 W. ASH STREET
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27530-1078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-947-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 101878 , 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)

  • Identifier: 8102482 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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