1245219799 NPI number — ACT MEDICAL GROUP PA

Table of content: (NPI 1245219799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245219799 NPI number — ACT MEDICAL GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACT MEDICAL GROUP 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:
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:
1245219799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 696
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-791-6767
Provider Business Mailing Address Fax Number:
910-791-6890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311-4E JUDGES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28405-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-791-6767
Provider Business Practice Location Address Fax Number:
910-791-6890
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEEKMAN
Authorized Official First Name:
ERINN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-791-6767

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 87550 , 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: 016UG . This is a "BCBSNC PRIMARY CARE ONLY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0706G . This is a "BCBSNC MENTAL HEALTH ONLY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890706G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005401 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI3714 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 20992 . This is a "PIEDMONT BEHAVIORAL HEALT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: E698 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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