1952570327 NPI number — BATHIA MEDICAL CORPORATION

Table of content: (NPI 1952570327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952570327 NPI number — BATHIA MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BATHIA MEDICAL CORPORATION
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:
MID-ATLANTIC RADIOLOGY
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:
1952570327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27892-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-792-8609
Provider Business Mailing Address Fax Number:
252-792-5664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 SOUTH MCCASKEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27892-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-792-8609
Provider Business Practice Location Address Fax Number:
252-792-5664
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BATHIA
Authorized Official First Name:
ANIL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
RADIOLOGIST
Authorized Official Telephone Number:
252-792-8609

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  36650 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13772 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8913772 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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