1356722235 NPI number — HOWARD CALHOUN

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 1356722235 NPI number — HOWARD CALHOUN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD CALHOUN
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:
1356722235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
586 HIGHWAY 701 N
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
LORIS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29569-2473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-756-7171
Provider Business Mailing Address Fax Number:
843-756-7176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
586 HIGHWAY 701 N
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
LORIS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29569-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-756-7171
Provider Business Practice Location Address Fax Number:
843-756-7176
Provider Enumeration Date:
06/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CALHOUN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED INDEPENDENT PRACTITIONER
Authorized Official Telephone Number:
843-756-7171

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1049 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 5488 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: S4485 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3410166 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005440 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6102665 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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