1821334996 NPI number — ROCKINHGAM MEDICAL CLINIC

Table of content: (NPI 1821334996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821334996 NPI number — ROCKINHGAM MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKINHGAM MEDICAL CLINIC
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:
1821334996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E MATTHEWS ST STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-5373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-339-7442
Provider Business Mailing Address Fax Number:
980-339-5925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 RANDOLPH RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-906-1676
Provider Business Practice Location Address Fax Number:
704-910-1420
Provider Enumeration Date:
12/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CAMARGO
Authorized Official First Name:
JOHNY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
704-910-2320

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34284 , 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: 2163710 . This is a "INDIVIDUAL MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5918242 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: A305 . This is a "GROUP MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P0100359 . This is a "RR MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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