1538323654 NPI number — DR. DAVID W. BANG, P.C.

Table of content: (NPI 1538323654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538323654 NPI number — DR. DAVID W. BANG, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DAVID W. BANG, P.C.
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:
6
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:
1538323654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 FAIRINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29485-8675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-764-3030
Provider Business Mailing Address Fax Number:
843-851-7448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9565 HIGHWAY 78
Provider Second Line Business Practice Location Address:
BUILDING 900
Provider Business Practice Location Address City Name:
LADSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29456-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-764-3030
Provider Business Practice Location Address Fax Number:
843-851-7448
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HALE-BANG
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
843-764-3030

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DG8451 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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