1477853786 NPI number — MR. PETER CHARLES SOULE LCAS-P

Table of content: MR. PETER CHARLES SOULE LCAS-P (NPI 1477853786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477853786 NPI number — MR. PETER CHARLES SOULE LCAS-P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOULE
Provider First Name:
PETER
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCAS-P
Provider Gender Code:
M

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:
1477853786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 NEW STATESIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27516-1165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-942-2803
Provider Business Mailing Address Fax Number:
919-942-2126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 S MADISON BLVD
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
ROXBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27573-5485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-599-8366
Provider Business Practice Location Address Fax Number:
336-322-6168
Provider Enumeration Date:
11/02/2010

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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