1629831060 NPI number — PATHOSP CONSULITNG

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629831060 NPI number — PATHOSP CONSULITNG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOSP CONSULITNG
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:
1629831060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
278 OLD HICKORY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27603-7240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-418-1246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9121 ANSON WAY STE 200
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:
27615-5857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-933-1204
Provider Business Practice Location Address Fax Number:
336-739-4188
Provider Enumeration Date:
01/30/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
JONES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-418-1246

Provider Taxonomy Codes

  • Taxonomy code: 163WA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0807X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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