1932151305 NPI number — CAROLINA EAR & HEARING CLINIC, PC

Table of content: (NPI 1932151305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932151305 NPI number — CAROLINA EAR & HEARING CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA EAR & HEARING CLINIC, PC
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:
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:
1932151305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 SIX FORKS RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-3838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-876-4327
Provider Business Mailing Address Fax Number:
919-876-6800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 SIX FORKS RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-876-4327
Provider Business Practice Location Address Fax Number:
919-876-6800
Provider Enumeration Date:
05/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCELVEEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-876-4327

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CI7813 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3404298 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0290P . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".