1285803668 NPI number — DEBRA MINOR-SCHORK LLC

Table of content: (NPI 1285803668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285803668 NPI number — DEBRA MINOR-SCHORK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEBRA MINOR-SCHORK LLC
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:
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:
1285803668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 MONTPELIER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDENTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27932-8909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
125-263-2406
Provider Business Mailing Address Fax Number:
252-482-5713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 EAST ELIZABETH STREET
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-526-8833
Provider Business Practice Location Address Fax Number:
252-482-7462
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MINOR-SCHORK
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
CLINICAL NURSE SPECIALIST
Authorized Official Telephone Number:
252-632-4063

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  100093 , 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: 6004040 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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