1740363449 NPI number — NORTH CAROLINA REGIONAL NETWORK

Table of content: (NPI 1740363449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740363449 NPI number — NORTH CAROLINA REGIONAL NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA REGIONAL NETWORK
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:
RUTHERFORD FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1740363449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4304
Provider Business Mailing Address Fax Number:
864-560-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 NC HIGHWAY 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTHERFORDTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28139-7871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-286-2302
Provider Business Practice Location Address Fax Number:
828-287-4320
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AYCOCK
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
864-560-6000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2343808 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK6810 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 790250Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN1627 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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