1174821599 NPI number — THE C W WILLIAMS COMMUNITY HEALTH CENTER INC

Table of content: (NPI 1174821599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174821599 NPI number — THE C W WILLIAMS COMMUNITY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE C W WILLIAMS COMMUNITY HEALTH CENTER 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:
Provider Other Organization Name Type Code:
6
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:
1174821599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668093
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28266-8093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-393-7720
Provider Business Mailing Address Fax Number:
704-391-0729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 EAST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-393-7720
Provider Business Practice Location Address Fax Number:
704-335-3770
Provider Enumeration Date:
03/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
704-393-7720

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  10972 , 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: 3458557 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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