1295818441 NPI number — CAROLINA PREMIER HEALTH CARE PA

Table of content: (NPI 1295818441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295818441 NPI number — CAROLINA PREMIER HEALTH CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA PREMIER HEALTH CARE PA
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:
1295818441
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:
630 S BENNETT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-693-1678
Provider Business Mailing Address Fax Number:
910-693-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S BENNETT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-693-1678
Provider Business Practice Location Address Fax Number:
910-693-1612
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-693-1698

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  38219 , 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: 022757 . This is a "DOCTORS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01241 . This is a "GROUP BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 80897 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 56142 . This is a "HEALTHCARE SAVINGS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8980897 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: FH2000455 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89012H1 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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