1265402408 NPI number — KENDALL REID OLVEY

Table of content: (NPI 1265402408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265402408 NPI number — KENDALL REID OLVEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENDALL REID OLVEY
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:
1265402408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28388-0749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-692-7928
Provider Business Mailing Address Fax Number:
910-692-5962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 APPLECROSS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-692-7928
Provider Business Practice Location Address Fax Number:
910-692-5962
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLVEY
Authorized Official First Name:
KENDALL
Authorized Official Middle Name:
REID
Authorized Official Title or Position:
OB GYN PHYSICIAN
Authorized Official Telephone Number:
910-692-7928

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  130221 , 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: 5904011 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com