1508821992 NPI number — DR. RICHARD GARTH BERRY MD, FACP, FACGS

Table of content: DR. RICHARD GARTH BERRY MD, FACP, FACGS (NPI 1508821992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508821992 NPI number — DR. RICHARD GARTH BERRY MD, FACP, FACGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
RICHARD
Provider Middle Name:
GARTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FACP, FACGS
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:
1508821992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1527
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-642-0300
Provider Business Mailing Address Fax Number:
910-640-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 HILL PLZ STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-0300
Provider Business Practice Location Address Fax Number:
910-640-3327
Provider Enumeration Date:
04/19/2006

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: 207R00000X , with the licence number:  36494 , 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: 0245H . This is a "FEDERAL BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110069099 . This is a "PALMETTA GBA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89013UY , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8915212 . This is a "NC MEDICAID - INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 141838016 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 15212 . This is a "BCBS - INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 080190419 . This is a "RAILROAD MEDICARE - INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 141838016 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 15212 . This is a "FEDERAL BCBS- INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 216449 . This is a "COVENTRY HEALTH CARE PLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "BLUECROSS BLUESHIELD STATE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: N36494 . This is a "SOUTH CAROLINA MEDICAID- INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 15212 . This is a "BCBS STATE - INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7067596009 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CK5068 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: N36494 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4140662 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0245H . This is a "OPTION BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 15212 . This is a "OPTION BCBS- INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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