1811353451 NPI number — AVA V HINTON PLLC

Table of content: TARA PHILANDER B.S.W (NPI 1164805339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811353451 NPI number — AVA V HINTON PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVA V HINTON PLLC
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:
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:
1811353451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 E ALTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-286-2283
Provider Business Mailing Address Fax Number:
866-433-8408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1058 W CLUB BLVD
Provider Second Line Business Practice Location Address:
STE 602
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-286-2283
Provider Business Practice Location Address Fax Number:
866-433-8408
Provider Enumeration Date:
01/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HINTON
Authorized Official First Name:
AVA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-286-3358

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  2655-A , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 8759 , 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)

  • Identifier: 6604292 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com