1265517122 NPI number — JONATHAN LAWRENCE LANGSTON PAC

Table of content: JONATHAN LAWRENCE LANGSTON PAC (NPI 1265517122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265517122 NPI number — JONATHAN LAWRENCE LANGSTON PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGSTON
Provider First Name:
JONATHAN
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
M

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:
1265517122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHALLOTTE MEDICAL CENTER INC
Provider Second Line Business Mailing Address:
PO BOX 2561
Provider Business Mailing Address City Name:
SHALLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-754-8731
Provider Business Mailing Address Fax Number:
910-754-3153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHALLOTTE MEDICAL CENTER INC
Provider Second Line Business Practice Location Address:
341A WHITEVILLE RD
Provider Business Practice Location Address City Name:
SHALLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-754-8731
Provider Business Practice Location Address Fax Number:
910-754-3153
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  100214 , 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)





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