1821341470 NPI number — MICHAEL O REIMELS DDS PA IV

Table of content: DR. SHELBY JACE BEATTIE DDS (NPI 1295073377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821341470 NPI number — MICHAEL O REIMELS DDS PA IV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL O REIMELS DDS PA IV
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:
1821341470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 SPRUCE ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28012-3385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-825-3455
Provider Business Mailing Address Fax Number:
704-825-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28012-3385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-825-3455
Provider Business Practice Location Address Fax Number:
704-825-3480
Provider Enumeration Date:
10/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
704-825-3455

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7919 , 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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