1689731705 NPI number — PIGGLY WIGGLY HOLLYWOOD INC

Table of content: (NPI 1689731705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689731705 NPI number — PIGGLY WIGGLY HOLLYWOOD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIGGLY WIGGLY HOLLYWOOD INC
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:
6
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:
1689731705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29423-8047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-554-9880
Provider Business Mailing Address Fax Number:
843-202-8211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6251 HIGHWAY 162
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29449-5782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-889-6866
Provider Business Practice Location Address Fax Number:
843-889-4976
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOOLS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
843-554-9880

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5001839 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5001839 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 718395 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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