1477508505 NPI number — CAROLINA VASCULAR SURGERY AND

Table of content: (NPI 1477508505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477508505 NPI number — CAROLINA VASCULAR SURGERY AND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA VASCULAR SURGERY AND
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:
1477508505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3713 BENSON DRIVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-7372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-235-3400
Provider Business Mailing Address Fax Number:
919-235-3401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3713 BENSON DRIVE, SUITE 201
Provider Second Line Business Practice Location Address:
CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-7372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-235-3400
Provider Business Practice Location Address Fax Number:
919-235-3401
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOGARTIE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
919-235-3400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89014EK , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA1192 . This is a "RAILROAD MEDIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: IP096 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 464895 . This is a "ANTHEM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 014EK . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DA1192 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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