1295716744 NPI number — ROWAN MEDICAL PRACTICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295716744 NPI number — ROWAN MEDICAL PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROWAN MEDICAL PRACTICE
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:
COOLEEMEE FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1295716744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 E CENTERVIEW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINA GROVE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28023-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-855-2400
Provider Business Mailing Address Fax Number:
704-857-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 MARGINAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOLEEMEE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-284-2331
Provider Business Practice Location Address Fax Number:
704-284-2988
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARKHAM
Authorized Official First Name:
MARLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP CFO
Authorized Official Telephone Number:
704-210-5000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 790184Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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