1720175144 NPI number — LINDA K MITCHELL-FRYE M.D.

Table of content: LINDA K MITCHELL-FRYE M.D. (NPI 1720175144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720175144 NPI number — LINDA K MITCHELL-FRYE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL-FRYE
Provider First Name:
LINDA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1720175144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 MCALPINE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAURINBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28352-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-277-3331
Provider Business Mailing Address Fax Number:
910-277-3336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 MCALPINE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAURINBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28352-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-277-3331
Provider Business Practice Location Address Fax Number:
910-277-3336
Provider Enumeration Date:
10/06/2006

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: 207V00000X , with the licence number:  39911 , 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: 59565 . This is a "BCBS ID NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: N39911 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8959565 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160048341 . This is a "RAILROAD MEDICARE ID NUMB" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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