1447720412 NPI number — WILLIAM ANTHONY MCGRATH SOIDC

Table of content: WILLIAM ANTHONY MCGRATH SOIDC (NPI 1447720412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447720412 NPI number — WILLIAM ANTHONY MCGRATH SOIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGRATH
Provider First Name:
WILLIAM
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOIDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGRATH
Provider Other First Name:
WILLIAM
Provider Other Middle Name:
ANTHONY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SOIDC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447720412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3D MARINE RAIDER BATTALION
Provider Second Line Business Mailing Address:
PSC BOX 20073
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-440-1947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3D MARINE RAIDER BATTALION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-440-1947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2018

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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