1922193622 NPI number — WHITE OAK FAMILY PHYSICIANS, PA

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 1922193622 NPI number — WHITE OAK FAMILY PHYSICIANS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE OAK FAMILY PHYSICIANS, 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:
WHITE OAK URGENT CARE ASHEBORO
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:
1922193622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 WHITE OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27203-4710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-625-1360
Provider Business Mailing Address Fax Number:
336-625-1889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
197 B HIGHWAY 42 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-625-2560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORE
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
336-625-1360

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 790249Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0249Y . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com