1528195906 NPI number — PAMLICO PEDIATRICS, PC

Table of content: (NPI 1528195906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528195906 NPI number — PAMLICO PEDIATRICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMLICO PEDIATRICS, PC
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:
1528195906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-745-2070
Provider Business Mailing Address Fax Number:
252-745-2202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13531 HWY 55 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-2070
Provider Business Practice Location Address Fax Number:
252-745-2202
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
252-745-2070

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  0039010 , 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: 012G9 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89012G9 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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