1518961275 NPI number — DR. BRIAN WAYNE BELL M.D.

Table of content: DR. BRIAN WAYNE BELL M.D. (NPI 1518961275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518961275 NPI number — DR. BRIAN WAYNE BELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELL
Provider First Name:
BRIAN
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1518961275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601884
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-1884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-245-3158
Provider Business Mailing Address Fax Number:
828-247-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28043-3585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-245-3158
Provider Business Practice Location Address Fax Number:
828-247-6484
Provider Enumeration Date:
06/10/2005

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: 207Q00000X , with the licence number:  18850 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 9701245 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QH0002X , with the licence number: 9701245 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1518961275 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188503 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891345U , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00362116 . This is a "MEDICARE RAILROAD PROVIDE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P01077510 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1345U . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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