1053509653 NPI number — THE DOCTORS OFFICE PA

Table of content: (NPI 1053509653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053509653 NPI number — THE DOCTORS OFFICE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DOCTORS OFFICE PA
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:
1053509653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BERN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28561-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-672-7741
Provider Business Mailing Address Fax Number:
252-672-7758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 EMERALD DR
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
EMERALD ISLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28594-2846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-354-6500
Provider Business Practice Location Address Fax Number:
252-354-5060
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-354-6500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053509653 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5908353 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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