1306918123 NPI number — DR. KINGSLEY CHUKS UGOCHUKWU MD

Table of content: DR. KINGSLEY CHUKS UGOCHUKWU MD (NPI 1306918123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306918123 NPI number — DR. KINGSLEY CHUKS UGOCHUKWU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGOCHUKWU
Provider First Name:
KINGSLEY
Provider Middle Name:
CHUKS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1306918123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 517
Provider Second Line Business Mailing Address:
ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC
Provider Business Mailing Address City Name:
FUQUAY-VARINA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27526-0512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-577-0481
Provider Business Mailing Address Fax Number:
919-577-0512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 LAKESTONE COMMONS AVENUE
Provider Second Line Business Practice Location Address:
ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC
Provider Business Practice Location Address City Name:
FUQUAY-VARINA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27526-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-577-0481
Provider Business Practice Location Address Fax Number:
919-577-0512
Provider Enumeration Date:
11/15/2006

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: 207Q00000X , with the licence number:  200400088 , 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: 2384996 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 218912 . This is a "WELL PATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2932032 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 136U6 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8913646 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00255190 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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