1366437915 NPI number — METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA

Table of content: (NPI 1366437915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366437915 NPI number — METROVIEW VASCULAR AND SURGICAL SPECIALISTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROVIEW VASCULAR AND SURGICAL SPECIALISTS, 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:
1366437915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28055-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-864-6500
Provider Business Mailing Address Fax Number:
704-864-0104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 MAJESTIC CT STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-5190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-864-6500
Provider Business Practice Location Address Fax Number:
704-864-0104
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EZE
Authorized Official First Name:
AUGUSTINE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-864-6500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  9600205 , 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: 16674 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1036M . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5900575 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7152565 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPA752 . This is a "SC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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