1972554186 NPI number — DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO

Table of content: (NPI 1972554186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972554186 NPI number — DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS FARRELL, FARRELL, NALE, COOK, KAPITAN, MOHAMED, FRANCO, WESSEL, HO
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:
6
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:
1972554186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 77 CENTER DR STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28217-0739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-295-4653
Provider Business Mailing Address Fax Number:
704-295-4288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 BILLINGSLEY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-347-3900
Provider Business Practice Location Address Fax Number:
704-347-0133
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOCK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
RAYLE
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
704-295-4653

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890328M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZAN993 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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