1407960818 NPI number — JOAN M FRACALOSSI MEMMGR-R&J RAMPS LLC

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 1407960818 NPI number — JOAN M FRACALOSSI MEMMGR-R&J RAMPS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRACALOSSI
Provider First Name:
JOAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MEMMGR-R&J RAMPS LLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRACALOSSI
Provider Other First Name:
RONALD
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MEM-R&J RAMPS LLC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1407960818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10196 STONEYBROOK CT SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LELAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28451-8474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-383-2560
Provider Business Mailing Address Fax Number:
866-294-2371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10196 STONEYBROOK CT SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LELAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28451-8474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-383-2560
Provider Business Practice Location Address Fax Number:
866-294-2371
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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