1194854075 NPI number — INNOVATIVE PROGRAMMING ASSOCIATES, INC.

Table of content: (NPI 1194854075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194854075 NPI number — INNOVATIVE PROGRAMMING ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE PROGRAMMING ASSOCIATES, 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:
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:
1194854075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 LAMON ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28301-4957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-483-0734
Provider Business Mailing Address Fax Number:
910-483-9403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4011 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-683-5672
Provider Business Practice Location Address Fax Number:
919-403-0420
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLEY
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING ASSISTANT
Authorized Official Telephone Number:
910-483-0734

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , 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: 8301288R , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301288 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301288G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301288B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301288H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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