1326414905 NPI number — RUTHERFORD OB-GYN ASSOCIATES PA

Table of content: (NPI 1326414905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326414905 NPI number — RUTHERFORD OB-GYN ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTHERFORD OB-GYN ASSOCIATES 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:
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:
1326414905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 YAMATO RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-4438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-300-2410
Provider Business Mailing Address Fax Number:
561-235-7292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
446 NC 108 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTHERFORDTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28139-7871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-287-7383
Provider Business Practice Location Address Fax Number:
828-287-8020
Provider Enumeration Date:
08/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VALLADARES
Authorized Official First Name:
DINA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER OF CREDENTIALING
Authorized Official Telephone Number:
561-300-2410

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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)





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