1417943788 NPI number — BENTON S SATTERFIELD MD PA

Table of content: REBECCA RAE BREITRICK LPC (NPI 1477069458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417943788 NPI number — BENTON S SATTERFIELD MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENTON S SATTERFIELD MD 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:
1417943788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 BLUE RIDGE RD
Provider Second Line Business Mailing Address:
STE G50
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-6474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-783-0960
Provider Business Mailing Address Fax Number:
919-782-4719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 BLUE RIDGE RD
Provider Second Line Business Practice Location Address:
STE G50
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-783-0960
Provider Business Practice Location Address Fax Number:
919-782-4719
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HODGSON
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
919-783-0960

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 74584 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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