1952492316 NPI number — USCG MEDICAL CLINIC ELIZABETH CITY

Table of content: (NPI 1952492316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952492316 NPI number — USCG MEDICAL CLINIC ELIZABETH CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USCG MEDICAL CLINIC ELIZABETH CITY
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:
STEPHEN C. PUSH MEMORIAL CLINIC
Provider Other Organization Name Type Code:
4
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:
1952492316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMDT CG-1122 U S
Provider Second Line Business Mailing Address:
2100 2ND ST SW, SUITE 5314
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20593-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMDT CG-1122 U S
Provider Second Line Business Practice Location Address:
2100 2ND ST SW, SUITE 5314
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20593-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-6461
Provider Business Practice Location Address Fax Number:
252-335-6255
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEFEBRE
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
ENRIQUE
Authorized Official Title or Position:
TECHNICIAN
Authorized Official Telephone Number:
252-335-6461

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com