1497733554 NPI number — HIGH POINT RADIOLOGICAL SERVICES

Table of content: (NPI 1497733554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497733554 NPI number — HIGH POINT RADIOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH POINT RADIOLOGICAL SERVICES
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:
1497733554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-882-1416
Provider Business Mailing Address Fax Number:
336-882-8264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 EASTCHESTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-882-1416
Provider Business Practice Location Address Fax Number:
336-882-8264
Provider Enumeration Date:
01/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
336-882-1416

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01785 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8901785 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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