1215018049 NPI number — UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE

Table of content: (NPI 1215018049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215018049 NPI number — UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE
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:
1215018049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9201 UNIVERSITY CITY BLVD
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:
28223-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-687-2812
Provider Business Mailing Address Fax Number:
704-687-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9201 UNIVERSITY CITY 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:
28223-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-687-7400
Provider Business Practice Location Address Fax Number:
704-687-7400
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PISCITELLI
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
704-687-7418

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  4585 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3427538 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 680950 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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