1326105933 NPI number — MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA

Table of content: (NPI 1326105933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326105933 NPI number — MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWS LUTCAVAGE SMITH VINTON FIDLER LONG & ARMSTRONG 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:
1326105933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 OFFICE PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28546-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-353-3535
Provider Business Mailing Address Fax Number:
910-353-9754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 OFFICE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-353-3535
Provider Business Practice Location Address Fax Number:
910-353-3535
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEADOWS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
910-353-3535

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  3953 , 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: 744032 . This is a "UCCI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02601 . This is a "BCBS GROUP #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8902601 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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