1689183972 NPI number — COX FAMILY MEDICINE

Table of content: (NPI 1689183972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689183972 NPI number — COX FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COX FAMILY MEDICINE
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:
1689183972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTHERFORD COLLEGE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28671-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-522-1290
Provider Business Mailing Address Fax Number:
828-522-1292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 MALCOLM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNELLY SPRINGS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28612-7918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-522-1290
Provider Business Practice Location Address Fax Number:
828-522-1292
Provider Enumeration Date:
09/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-522-1290

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2005-01297 , 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: 5903130 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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