1205892890 NPI number — GUILFORD NEUROLOGIC ASSOCIATES, INC.

Table of content: (NPI 1205892890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205892890 NPI number — GUILFORD NEUROLOGIC ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUILFORD NEUROLOGIC 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:
1205892890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27429-9568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-273-2511
Provider Business Mailing Address Fax Number:
336-370-0287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 THIRD STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-6967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-273-2511
Provider Business Practice Location Address Fax Number:
336-370-0287
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SKELTON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
336-272-2511

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  041013491 , 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: 1205892890 . This is a "PALMETTO GBA RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8901685 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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