1245304724 NPI number — COUNTY OF CATAWBA OFFICE OF ACCOUNTANT

Table of content: (NPI 1245304724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245304724 NPI number — COUNTY OF CATAWBA OFFICE OF ACCOUNTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CATAWBA OFFICE OF ACCOUNTANT
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:
1245304724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1985 TATE BLVD SE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28602-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-328-5960
Provider Business Mailing Address Fax Number:
828-328-4729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28658-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-464-0013
Provider Business Practice Location Address Fax Number:
828-464-8471
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAPPELLETTY
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
828-326-5960

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0728U . This is a "BCBS NCHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8301044 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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