1225447980 NPI number — MEDPARTNERS, CORP.

Table of content: (NPI 1225447980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225447980 NPI number — MEDPARTNERS, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDPARTNERS, CORP.
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:
1225447980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 AIRPORT RD
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
FLETCHER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28732-6712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-572-3330
Provider Business Mailing Address Fax Number:
888-579-6040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 AIRPORT RD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
FLETCHER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28732-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-572-3330
Provider Business Practice Location Address Fax Number:
888-579-6040
Provider Enumeration Date:
08/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BLAND
Authorized Official First Name:
PHIL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-283-2728

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  02197 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 02197 , 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: 1225447980 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com