1912982042 NPI number — THOMAS FREEMAN SLAUGHTER MD

Table of content: DR. JERE SANDEFUR M.D. (NPI 1790744928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912982042 NPI number — THOMAS FREEMAN SLAUGHTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLAUGHTER
Provider First Name:
THOMAS
Provider Middle Name:
FREEMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1912982042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27102-0344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-2255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2005

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: 207L00000X , with the licence number:  34738 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: 34738 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 13034 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q34738 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7258304 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76885 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: D4334 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810000399 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8976885 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00203339 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10087139 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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