1407958226 NPI number — EAGLE PHYSICIANS AND ASSOCIATES PA

Table of content: DR. IRWIN FRIED PHD (NPI 1346266012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407958226 NPI number — EAGLE PHYSICIANS AND ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE PHYSICIANS AND 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:
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:
1407958226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14883
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27415-4883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-268-3380
Provider Business Mailing Address Fax Number:
336-268-3381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E WENDOVER AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-268-3380
Provider Business Practice Location Address Fax Number:
336-268-3381
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
DIRECTOR, EAGLE BUSINESS SERVICES
Authorized Official Telephone Number:
336-268-3201

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89014EX , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014EX . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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