1639167620 NPI number — MR. MICHAEL G BISSELL CPO, FAAOP

Table of content: MR. MICHAEL G BISSELL CPO, FAAOP (NPI 1639167620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639167620 NPI number — MR. MICHAEL G BISSELL CPO, FAAOP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISSELL
Provider First Name:
MICHAEL
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPO, FAAOP
Provider Gender Code:
M

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:
1639167620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 SAINT LEOS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-621-9500
Provider Business Mailing Address Fax Number:
336-621-0980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3680 WESTGATE CENTER CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-768-1933
Provider Business Practice Location Address Fax Number:
336-768-4869
Provider Enumeration Date:
10/12/2005

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: 1744P3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 222Z00000X , with the licence number: CP001225 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 224P00000X , with the licence number: CP001225 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4496224 . This is a "PROVIDER # NON HMO AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7795063 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0487N . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2021053 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7703164 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9110925 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: A9348 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 32953 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com