1912946849 NPI number — CANCER CARE OF WNC, PA

Table of content: (NPI 1912946849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912946849 NPI number — CANCER CARE OF WNC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CARE OF WNC, PA
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:
CANCER CARE OF WNC, PA AT BREVARD
Provider Other Organization Name Type Code:
5
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:
1912946849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HOSPITAL DR
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28801-4550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-253-4262
Provider Business Mailing Address Fax Number:
828-418-0926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 NEELY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-4267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-883-3987
Provider Business Practice Location Address Fax Number:
828-884-8801
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAZLEY
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
828-253-4262

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 34D0860245 . This is a "CLIA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5906801 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02548 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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