1356391114 NPI number — HIGH POINT HEALTH CARE VENTURES

Table of content: (NPI 1356391114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356391114 NPI number — HIGH POINT HEALTH CARE VENTURES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH POINT HEALTH CARE VENTURES
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:
1356391114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W. RAY STREET
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-878-6064
Provider Business Mailing Address Fax Number:
336-878-6963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W. RAY STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-878-6064
Provider Business Practice Location Address Fax Number:
336-878-6963
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WELLMON
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
DIANNE
Authorized Official Title or Position:
DEPARTMENT OF PATHOLOGY
Authorized Official Telephone Number:
336-878-6064

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  LP00331 , 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: 7001193 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: LP00331 . This is a "STATE LIC PAP SCREENI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 34D0685109 . This is a "CLIA NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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