1275608499 NPI number — NORRIS RICK PHILBECK OD

Table of content: NORRIS RICK PHILBECK OD (NPI 1275608499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275608499 NPI number — NORRIS RICK PHILBECK OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILBECK
Provider First Name:
NORRIS
Provider Middle Name:
RICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1275608499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1544 OLDENBURG DR
Provider Second Line Business Mailing Address:
303
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29429-4966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-722-4416
Provider Business Mailing Address Fax Number:
843-720-8984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9270 N HIGHWAY 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC CLELLANVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29458-9422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-722-4416
Provider Business Practice Location Address Fax Number:
843-720-8984
Provider Enumeration Date:
11/22/2006

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: 152WC0802X , with the licence number:  509 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D05091 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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