1487753182 NPI number — SESSOMS MEDICAL ASSOCIATES, LLC

Table of content: (NPI 1487753182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487753182 NPI number — SESSOMS MEDICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SESSOMS MEDICAL ASSOCIATES, LLC
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:
SESSOMS MEDICAL PRACTICE, PA
Provider Other Organization Name Type Code:
4
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:
1487753182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 BEAMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28328-2602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-290-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 BEAMAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-596-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SESSOMS
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
SEC
Authorized Official Telephone Number:
910-596-2800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  33927 , 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: 2174820C . This is a "KIMBERLY GRIGSBY SESSOMS MEDICARE PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8975241 . This is a "MEDICAID KIMBERLY GRIGSBY-SESSOMS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8975252 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2172583D . This is a "OLD MEDICARE PIN RODNEY K SESSOMS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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