1093782690 NPI number — AMY N ARMSTRONG AA-C

Table of content: AMY N ARMSTRONG AA-C (NPI 1093782690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093782690 NPI number — AMY N ARMSTRONG AA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
AMY
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AA-C
Provider Gender Code:
F

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:
1093782690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 SPRING FOREST RD
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27616-2880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-873-9533
Provider Business Mailing Address Fax Number:
919-873-9821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3714 GUARDIAN AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-2974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-222-5862
Provider Business Practice Location Address Fax Number:
252-247-4675
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367H00000X , with the licence number:  67-000034 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367H00000X , with the licence number: 1000-00199 , 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: P00742939 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000505 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093782690 . This is a "TRICARE - NORTH REGION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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