1598702490 NPI number — RALEIGH NEUROSURGICAL CLINIC, INC.

Table of content: (NPI 1598702490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598702490 NPI number — RALEIGH NEUROSURGICAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALEIGH NEUROSURGICAL CLINIC, 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:
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:
1598702490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63082
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:
28263-3082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-785-3400
Provider Business Mailing Address Fax Number:
919-783-7778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5241 SIX FORKS ROAD, SUITE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-2760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-785-3400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODMAN
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-785-3400

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8902497 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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