1427156447 NPI number — ROXBORO MEDICAL ASSOCIATES, P.A.

Table of content: (NPI 1427156447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427156447 NPI number — ROXBORO MEDICAL ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROXBORO MEDICAL ASSOCIATES, P.A.
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:
1427156447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
783 DOCTORS COURT, P.O. BOX 1058
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROXBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27573-4571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-598-6034
Provider Business Mailing Address Fax Number:
336-598-6025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
783 DOCTORS COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROXBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27573-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-598-6034
Provider Business Practice Location Address Fax Number:
336-598-6025
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAFER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-598-6034

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  REGCERT40967 , 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: 1427156447 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890238C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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