1437343621 NPI number — TARBORO INTERNAL MEDICINE OF NORTH CAROLINA, PA

Table of content: (NPI 1437343621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437343621 NPI number — TARBORO INTERNAL MEDICINE OF NORTH CAROLINA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARBORO INTERNAL MEDICINE OF NORTH CAROLINA, 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:
1437343621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2704-C NORTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27886-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-823-0808
Provider Business Mailing Address Fax Number:
252-823-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2704-C NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27886-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-823-0808
Provider Business Practice Location Address Fax Number:
252-823-6010
Provider Enumeration Date:
08/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
EMMA
Authorized Official Middle Name:
EVERLYN
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
252-823-0808

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  200001464895 , 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: DO3424 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5900019 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020E2 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4213840 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".