1093866006 NPI number — MR. WILLIAM STEWART KETCHAM M.D.

Table of content: MRS. STEFANIE WALTZ MS, OTR/L (NPI 1629362009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093866006 NPI number — MR. WILLIAM STEWART KETCHAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KETCHAM
Provider First Name:
WILLIAM
Provider Middle Name:
STEWART
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1093866006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 HEALTH PARK DR
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-7051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-772-3487
Provider Business Mailing Address Fax Number:
919-772-3446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 HEALTH PARK DR
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-772-3487
Provider Business Practice Location Address Fax Number:
919-772-3446
Provider Enumeration Date:
01/16/2007

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: 207N00000X , with the licence number:  29605 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X , with the licence number: 29605 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 29605 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 070014474 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 30499 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4510902 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3330875-004 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 95508 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0273L . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 48795 . This is a "BCBS IND" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 562147357 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 290649 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com