1780901447 NPI number — MRS. RITA CRUMP WEATHERFORD MA

Table of content: MRS. RITA CRUMP WEATHERFORD MA (NPI 1780901447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780901447 NPI number — MRS. RITA CRUMP WEATHERFORD MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERFORD
Provider First Name:
RITA
Provider Middle Name:
CRUMP
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1780901447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 BOUCHELLE STREET
Provider Second Line Business Mailing Address:
PO BOX 2423
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-437-6268
Provider Business Mailing Address Fax Number:
828-437-6225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 BOUCHELLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-437-6268
Provider Business Practice Location Address Fax Number:
828-437-6225
Provider Enumeration Date:
04/21/2010

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: 103T00000X , with the licence number:  2389 , 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)





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