1205978640 NPI number — BRADLY J BUXTON DC PA

Table of content: (NPI 1205978640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205978640 NPI number — BRADLY J BUXTON DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADLY J BUXTON DC PA
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:
1205978640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2912 BATTLEGROUND AVE
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:
27408-2706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-282-2525
Provider Business Mailing Address Fax Number:
336-282-7554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2912 BATTLEGROUND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-282-2525
Provider Business Practice Location Address Fax Number:
336-282-7554
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUXTON
Authorized Official First Name:
BRADLY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
336-282-2525

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1251 , 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: 1369 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 330073 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08288 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 244335 . This is a "MEDICARE TYPE B" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8908288 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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