1760874549 NPI number — SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.

Table of content: (NPI 1760874549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760874549 NPI number — SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, 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:
1760874549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2722 PHILADELPHIA PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYMONT
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19703-2568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
26-556-1873
Provider Business Mailing Address Fax Number:
27-982-4733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2722 PHILADELPHIA PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYMONT
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19703-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-655-6187
Provider Business Practice Location Address Fax Number:
302-798-2473
Provider Enumeration Date:
03/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
NACHET
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
26-593-0773

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 440009 . This is a "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com