1750610960 NPI number — FEDERAL BUREAU OF PRISONS

Table of content: (NPI 1750610960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750610960 NPI number — FEDERAL BUREAU OF PRISONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEDERAL BUREAU OF PRISONS
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:
FEDERAL MEDICAL CENTER BUTNER
Provider Other Organization Name Type Code:
5
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:
1750610960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27509-4600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-575-3900
Provider Business Mailing Address Fax Number:
919-575-4821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OLD HWY 75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-575-3900
Provider Business Practice Location Address Fax Number:
919-575-4821
Provider Enumeration Date:
12/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUCHESNE
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
919-575-3900

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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