1245279223 NPI number — CANCER CARE OF WNC

Table of content: (NPI 1245279223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245279223 NPI number — CANCER CARE OF WNC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CARE OF WNC
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:
1245279223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28801-4550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-253-4262
Provider Business Mailing Address Fax Number:
828-418-0926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-253-4262
Provider Business Practice Location Address Fax Number:
828-252-9876
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAZLEY
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
828-253-4262

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5906624 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02548 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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