1093981300 NPI number — EMILIE CAMILLE RALSTON M.D.

Table of content: EMILIE CAMILLE RALSTON M.D. (NPI 1093981300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093981300 NPI number — EMILIE CAMILLE RALSTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RALSTON
Provider First Name:
EMILIE
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADY
Provider Other First Name:
EMILIE
Provider Other Middle Name:
CAMILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093981300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-1987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-213-0594
Provider Business Mailing Address Fax Number:
828-213-0590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
534 BILTMORE AVE
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-4612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-213-0800
Provider Business Practice Location Address Fax Number:
828-213-0804
Provider Enumeration Date:
05/06/2008

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: 2085R0202X , with the licence number:  2009-01312 , 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: 1093981300 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q12009 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810023699 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5920568 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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