1285801860 NPI number — MR. VERNON FULLER MITCHELL LLL RRT

Table of content: MR. VERNON FULLER MITCHELL LLL RRT (NPI 1285801860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285801860 NPI number — MR. VERNON FULLER MITCHELL LLL RRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL LLL
Provider First Name:
VERNON
Provider Middle Name:
FULLER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RRT
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:
1285801860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 JILMAR CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANDLER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28715-8348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-670-9064
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 TUNNEL ROAD
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-298-7911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2008

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: 2279G1100X , with the licence number:  RT3213 , 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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