1417180662 NPI number — INTERNAL MEDICINE &PSYCHIATRIC SERVICES OF THE PIEDMONT

Table of content: (NPI 1417180662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417180662 NPI number — INTERNAL MEDICINE &PSYCHIATRIC SERVICES OF THE PIEDMONT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE &PSYCHIATRIC SERVICES OF THE PIEDMONT
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:
1417180662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28603-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-325-0555
Provider Business Mailing Address Fax Number:
828-267-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 15TH ST NE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28601-4161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-325-0555
Provider Business Practice Location Address Fax Number:
828-267-7555
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KILLIAN
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
828-325-0555

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  200501179 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 200501179 , 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: 5913662 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022MM . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 513278 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DQ4195 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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