1639276421 NPI number — RICHARD H BYRNE MD

Table of content: RICHARD H BYRNE MD (NPI 1639276421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639276421 NPI number — RICHARD H BYRNE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRNE
Provider First Name:
RICHARD
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1639276421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602456
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:
28260-2456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-212-6200
Provider Business Mailing Address Fax Number:
980-212-6201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 MCALISTER RD
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
LINCOLNTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28092-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-212-6200
Provider Business Practice Location Address Fax Number:
980-212-6201
Provider Enumeration Date:
09/20/2006

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: 208800000X , with the licence number:  21951 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 2010-01628 , 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)

  • Identifier: P00272622 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4508291 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 328290 . This is a "CARELINK" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: NC1335 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810003183 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000422674 . This is a "BC/BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 5916118 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: WV21951 . This is a "HEALTH PLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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