1134695026 NPI number — NORTH CAROLINA CENTER FOR WEIGHT MANAGEMENT

Table of content: BRET RENEE FORD DPT (NPI 1750749008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134695026 NPI number — NORTH CAROLINA CENTER FOR WEIGHT MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA CENTER FOR WEIGHT MANAGEMENT
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:
1134695026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1370 NC 24-87 STE 174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28326-8571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-842-5566
Provider Business Mailing Address Fax Number:
919-375-2048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 MITTIE HADDOCK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMERON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28326-9379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-842-5566
Provider Business Practice Location Address Fax Number:
919-375-2048
Provider Enumeration Date:
10/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HOLDEN
Authorized Official First Name:
RONNITA
Authorized Official Middle Name:
EVETTE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
919-842-5566

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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