1598857773 NPI number — MISS ANGELA LANETTE BOYD MASTER

Table of content: MISS ANGELA LANETTE BOYD MASTER (NPI 1598857773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598857773 NPI number — MISS ANGELA LANETTE BOYD MASTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
ANGELA
Provider Middle Name:
LANETTE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MASTER
Provider Gender Code:
F

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:
1598857773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1547 PARKWAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29646-4081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-229-7120
Provider Business Mailing Address Fax Number:
864-229-5526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 TRAVIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALUDA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29138-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-445-8122
Provider Business Practice Location Address Fax Number:
864-445-9546
Provider Enumeration Date:
09/28/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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