1831555283 NPI number — PATTERSON PSYCH GROUP, PLLC

Table of content: (NPI 1831555283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831555283 NPI number — PATTERSON PSYCH GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATTERSON PSYCH GROUP, 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:
1831555283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1051 R P C RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29708-8015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-675-0470
Provider Business Mailing Address Fax Number:
866-309-6535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1554 UNION RD STE C
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-5581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-675-0470
Provider Business Practice Location Address Fax Number:
855-309-6535
Provider Enumeration Date:
01/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
BAGWELL
Authorized Official Title or Position:
OWNER/LEAD CLINICIAN
Authorized Official Telephone Number:
704-675-0470

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7176 , 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: 1861640500 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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