1518002807 NPI number — TROY SURGICAL CLINIC

Table of content: (NPI 1518002807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518002807 NPI number — TROY SURGICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TROY SURGICAL CLINIC
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:
1518002807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
522 ALLEN ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-571-5716
Provider Business Mailing Address Fax Number:
910-576-3367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
522 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-571-5716
Provider Business Practice Location Address Fax Number:
910-576-3367
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ACHREIA
Authorized Official First Name:
RANVIR
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
336-629-1596

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  27560 , 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: 10039 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8910039 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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