1245325000 NPI number — ROBERT C MILLS JR OD PA

Table of content: (NPI 1245325000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245325000 NPI number — ROBERT C MILLS JR OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT C MILLS JR OD 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:
1245325000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 S MCCASKEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27892-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-792-2250
Provider Business Mailing Address Fax Number:
252-792-6293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 S MCCASKEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27892-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-792-2250
Provider Business Practice Location Address Fax Number:
252-792-6293
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-792-2250

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NC1337 , 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: 8909654 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09654 . This is a "NC BSBC INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2415248 . This is a "UHC INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0124Q . This is a "NC BCBS GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 093N6 . This is a "NC BSBS INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1235178989 . This is a "MILLS INDIVIDUAL NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1861492019 . This is a "STERLING INDIVIDUAL NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5950097 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89093N6 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0346981 . This is a "CIGNA INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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