1477628105 NPI number — DUNN INTERNAL MEDICINE

Table of content: (NPI 1477628105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477628105 NPI number — DUNN INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNN INTERNAL MEDICINE
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:
1477628105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2007
NPI Reactivation Date:
09/11/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 TILGHMAN DR
Provider Second Line Business Mailing Address:
STE 724
Provider Business Mailing Address City Name:
DUNN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-892-0162
Provider Business Mailing Address Fax Number:
910-892-1145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 TILGHMAN DR
Provider Second Line Business Practice Location Address:
STE 724
Provider Business Practice Location Address City Name:
DUNN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-892-0162
Provider Business Practice Location Address Fax Number:
910-892-1145
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIDGLEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-892-0162

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  23131 , 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: 01452 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8901452 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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