1295771343 NPI number — THERAPEUTIC ALTERNATIVES INC

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 1295771343 NPI number — THERAPEUTIC ALTERNATIVES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC ALTERNATIVES INC
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:
6
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:
1295771343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 814
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDLEMAN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27317-0814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-495-2700
Provider Business Mailing Address Fax Number:
336-495-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAMSEUR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27316-9464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-625-1500
Provider Business Practice Location Address Fax Number:
336-625-2767
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURROW
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
336-495-2700

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  MHL 076 012 , 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: 7805060 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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