1487635454 NPI number — DRUID HILLS FAMILY PRACTICE

Table of content: (NPI 1487635454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487635454 NPI number — DRUID HILLS FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRUID HILLS FAMILY PRACTICE
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:
6
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:
1487635454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28793-5151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-698-7075
Provider Business Mailing Address Fax Number:
828-696-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 ASHEVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28791-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-698-7078
Provider Business Practice Location Address Fax Number:
828-696-1697
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
828-692-4289

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 344556A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 344556D , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0147G . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 344556C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2326610 . This is a "CIGNA MEDIARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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