1164418232 NPI number — GOLDSBORO EMERGENCY MEDICAL SPECIALISTS, INC.

Table of content: (NPI 1164418232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164418232 NPI number — GOLDSBORO EMERGENCY MEDICAL SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDSBORO EMERGENCY MEDICAL SPECIALISTS, INC.
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:
CORRECT LEGAL NAME
Provider Other Organization Name Type Code:
5
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:
1164418232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-580-0004
Provider Business Mailing Address Fax Number:
919-580-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 WAYNE MEMORIAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-731-6060
Provider Business Practice Location Address Fax Number:
919-587-2988
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GEER
Authorized Official First Name:
BRYON
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-580-0004

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 790149G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5922111 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0149G . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com