1326360579 NPI number — NORTH CAROLINA CENTRAL UNIVERSITY

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 1326360579 NPI number — NORTH CAROLINA CENTRAL UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA CENTRAL UNIVERSITY
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:
1326360579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 19491
Provider Second Line Business Mailing Address:
STUDENT HEALTH BUILDING
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-530-6317
Provider Business Mailing Address Fax Number:
919-530-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CAFETERIA DRIVE
Provider Second Line Business Practice Location Address:
STUDENT HEALTH BUILDING
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-0020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-530-6317
Provider Business Practice Location Address Fax Number:
919-530-7969
Provider Enumeration Date:
02/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM ALLEN
Authorized Official First Name:
IESCHECIA
Authorized Official Middle Name:
NYTONYA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-530-7908

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  34D0688623 , 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: AIH0085120 . This is a "PEARCE AND PEARCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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