1144575929 NPI number — CARDINAL HEALTH SERVICES, PC

Table of content: (NPI 1144575929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144575929 NPI number — CARDINAL HEALTH SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDINAL HEALTH SERVICES, PC
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:
1144575929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27130-0575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-448-0962
Provider Business Mailing Address Fax Number:
336-992-3930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3069 TRENWEST DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-448-0962
Provider Business Practice Location Address Fax Number:
336-992-3930
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TRIPP
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
FRANKLIN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
336-993-3146

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  32185 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: 32185 , 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: 34D2049903 . This is a "CLIA #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com