1144372483 NPI number — JODY DALE PAPAZEKOS OD

Table of content: (NPI 1144372483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144372483 NPI number — JODY DALE PAPAZEKOS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JODY DALE PAPAZEKOS OD
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:
1144372483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 13TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28601-3766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-322-3154
Provider Business Mailing Address Fax Number:
828-322-3154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 13TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28601-3766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-322-3154
Provider Business Practice Location Address Fax Number:
828-322-3154
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAPAZEKOS
Authorized Official First Name:
JODY
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
OWNER, PHYSICAN
Authorized Official Telephone Number:
828-322-3154

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1670 , 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: 890917M , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119986000 . This is a "DMERC PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0917M . This is a "BCBS PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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