1750443792 NPI number — CLEVELAND COUNTY HEALTHCARE SYSTEM

Table of content: (NPI 1750443792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750443792 NPI number — CLEVELAND COUNTY HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND COUNTY HEALTHCARE SYSTEM
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:
1750443792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E GROVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28150-3917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-487-3000
Provider Business Mailing Address Fax Number:
980-487-3690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 W KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGS MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28086-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-487-3802
Provider Business Practice Location Address Fax Number:
980-487-3690
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO VP
Authorized Official Telephone Number:
980-787-3802

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 198264 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 235034G . This is a "CIGNA PART B" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 303 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 07690 . This is a "BCBS 1500" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 308577 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8000153 - 1500 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261206 . This is a "CIGNA PART B" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000153 . This is a "CRNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 235066A . This is a "CIGNA PART B" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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