1609116854 NPI number — MISS ALI BOYCE COSGROVE NP-C, CRNA

Table of content: MISS ALI BOYCE COSGROVE NP-C, CRNA (NPI 1609116854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609116854 NPI number — MISS ALI BOYCE COSGROVE NP-C, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSGROVE
Provider First Name:
ALI
Provider Middle Name:
BOYCE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NP-C, CRNA
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:
1609116854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602373
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:
28260-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 BILTMORE AVE
Provider Second Line Business Practice Location Address:
ADVANCED CARDIAC CARE CLINIC & MISSION
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-4601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-213-0152
Provider Business Practice Location Address Fax Number:
828-213-7053
Provider Enumeration Date:
02/26/2013

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: 363L00000X , with the licence number:  225635 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 5006083 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 6698 , 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)