1508918293 NPI number — CHRISTOPHERSON FAMILY MEDICINE, LLC

Table of content: (NPI 1508918293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508918293 NPI number — CHRISTOPHERSON FAMILY MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHERSON FAMILY MEDICINE, 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:
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:
1508918293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 PENNY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-403-2680
Provider Business Mailing Address Fax Number:
704-784-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 PENNY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-2680
Provider Business Practice Location Address Fax Number:
704-784-4346
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAYMON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
F
Authorized Official Title or Position:
SR. VICE PRESIDENT
Authorized Official Telephone Number:
704-403-2276

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34832 , 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: 011JE . This is a "BCBS NC OLD GROUP#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5905765 . This is a "MEDICAID OLD GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DF5941 . This is a "RAILROAD MEDICARE PTAN, GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 892247A . This is a "MEDICAID OLD GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5906984 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com