1033124987 NPI number — INGLES MARKETS INC

Table of content: (NPI 1033124987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033124987 NPI number — INGLES MARKETS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INGLES MARKETS INC
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:
1033124987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 603941
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:
28260-3941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-669-2941
Provider Business Mailing Address Fax Number:
828-669-3685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
283 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-867-7116
Provider Business Practice Location Address Fax Number:
770-586-0225
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUCCHI
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
VICE PRESIDENT OF PHARMACY
Authorized Official Telephone Number:
828-669-2941

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE009041 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 973843197A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154537 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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