1588959225 NPI number — HEALTHACCESS, INC.

Table of content: (NPI 1588959225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588959225 NPI number — HEALTHACCESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHACCESS, INC.
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:
1588959225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27835-8125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-847-7830
Provider Business Mailing Address Fax Number:
252-847-7910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 HIGHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-975-8330
Provider Business Practice Location Address Fax Number:
252-948-4801
Provider Enumeration Date:
06/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLASS
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
252-847-9168

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC1634 , 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: 3407250 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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