1225069792 NPI number — DR. KEVIN DWAYNE BIGHAM OD

Table of content: DR. KEVIN DWAYNE BIGHAM OD (NPI 1225069792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225069792 NPI number — DR. KEVIN DWAYNE BIGHAM OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIGHAM
Provider First Name:
KEVIN
Provider Middle Name:
DWAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1225069792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14617 LAWYERS RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28104-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-893-0090
Provider Business Mailing Address Fax Number:
704-893-0944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14617 LAWYERS RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28104-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-893-0090
Provider Business Practice Location Address Fax Number:
704-893-0944
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1746 , 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: 68011 . This is a "BEACHSTREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90703 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 890925E , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22.00365 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: B9267 . This is a "MEDCOST PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: DD2824 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0925E . This is a "BLUE CROSS BLUE SHIELD NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803877 . This is a "COMMUNITY EYE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803877 . This is a "PARTNERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ND1746 . This is a "VISION BENEFITS OF AMER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24119 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".




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