1245776889 NPI number — CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC

Table of content: (NPI 1245776889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245776889 NPI number — CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CABARRUS GASTROENTEROLOGY ASSOCIATES, PLLC
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:
NORTHEAST DIGESTIVE HEALTH CENTER EDISON SQUARE
Provider Other Organization Name Type Code:
3
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:
1245776889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 VINEHAVEN DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-2438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-783-1840
Provider Business Mailing Address Fax Number:
704-783-1850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10030 EDISON SQUARE DR NW
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28027-8308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-783-1840
Provider Business Practice Location Address Fax Number:
704-783-1850
Provider Enumeration Date:
01/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ALDOUS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
704-783-1840

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  AS0104 , 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: 1508279043 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8971386 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194142422 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710009300 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891031V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89136HK , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8926776 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5904428 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396923322 . This is a "NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89128WY , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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